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Clinicopathological characteristics and renal outcomes of childhood-onset lupus nephritis with acute kidney injury: A multicenter study

Mod Rheumatol. 2018 Oct 5:1-17. doi: 10.1080/14397595.2018.1532861. [Epub ahead of print]Clinicopathological characteristics and renal outcomes of childhood-onset lupus nephritis with acute kidney injury: a multicenter study.Ishimori S1,2, Kaito H1, Shima Y3, Kamioka I2, Hamahira K4, Nozu K1, Nakanishi K5, Tanaka R6, Yoshikawa N7, Iijima K1.Author information1a Department of Pediatrics , Kobe University Graduate School of Medicine , Hyogo , Japan.2b Department of Pediatrics , Kakogawa Central City Hospital , Hyogo , Japan.3c Department of Pediatrics , Wakayama Medical University , Wakayama , Japan.4d Department of Pediatrics , Himeji Red-Cress Hospital , Hyogo , Japan.5e Department of Pediatrics , Ryukyu University Graduate School of Medicine , Okinawa , Japan.6f Department of Nephrology , Hyogo Prefectural Kobe Children's Hospital , Hyogo , Japan.7g Clinical Research Center, Wakayama Medical University , Wakayama , Japan.AbstractOBJECTIVES: Acute kidney injury (AKI) at onset of adult systemic lupus erythematosus (SLE) is a risk factor for end stage kidney disease (ESKD). However, data on childhood-onset lupus nephritis (LN) with AKI are scarce.METHODS: We retrospectively reviewed the complete files of pediatric SLE patients from 1995 to 2010. All patients underwent kidney biopsy promptly after diagnosis.RESULTS: Thirty-six patients (10 males and 26 females) were enrolled. Mean age at diagnosis and observation period were 11.6 ± 2.4 years and 8.1 ± 4.4 years, respectively. Seven patients had AKI at onset of SLE. Compared with those without AKI, patients with AKI had significantly higher proportions of pathologically proliferative LN. Only one patient with AKI progressed to ESKD without complete recovery of renal function. Overall and renal survival rates were 100% and 97.2%, respectively. There was no significant difference in estimated glomerular filtration rate at the final visit (85.0 ml/min/1.73 m2 in the AKI group vs. 103.2 ml/min/1.73 m2 in the non-AKI group; p = 0.11).CONCLUSIONS: Our study demonstrated favorable renal outcomes in childhood-onset LN with AKI in the near to midterm period. Inducing complete remission may be important for preserving renal function.KEYWORDS: Acute kidney injury; Childhood-onset; Lupus nephritis; Renal prognosis; Systemic lupus erythematosusPMID: 30289013 DOI: 10.1080/14397595.2018.1532861 Share

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