Outcomes of children with proliferative lupus nephritis: The role of protocol renal biopsy

David Askenazi, Barry Myones, Ankur Kamdar, Robert Warren, Maria Perez, Marietta Guzman, Anna Minta, M. John Hicks, Arundhati S Kale

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42 Scopus citations

Abstract

Outcomes in children with proliferate lupus nephritis (PLN) show 9-15% progress to end-stage renal disease (ESRD) at 5 years. Immunosuppression improves outcome, but significant side effects are possible. Clinical and laboratory analyses are poor predictors of class and progression in PLN. We describe 28 patients with systemic lupus erythematosus (SLE), between 1990 and 2005, whose initial biopsy (Bx1) showed PLN and who received nine monthly doses of intravenously administered cyclophosphamide (CYP) (500-750 mg/m2 up to 1 g to maintain their absolute neutrophil count (ANC) > 3,000). Continued therapy with additional quarterly intravenous (i.v). administration of CYP was dictated by repeat renal biopsy (Bx2). Bx1 was done 1±1.6 years after diagnosis of SLE. Bx2 showed histological improvement by WHO classification in 20/25 children; 3/25 were unchanged, 1/25 was categorized as new class V, and 1/25 was worse. Four patients (14%) had infectious complications requiring hospitalization (one of these died). Mean follow-up (f/u) after Bx2 was 3.5±2.3 years. At last follow-up, 26 patients had normal glomerular filtration rate (GFR), with a mean of 126±42.8 ml/min per 1.73 m2 body surface area, one non-compliant patient had ESRD, and one had chronic renal failure. At last follow-up, most patients had minimal to no proteinuria. Clinical and biopsy results greatly improved after 9 monthly intravenously administered CYP pulses in most children with class IV PLN. Those who did not improve are at risk for flares and progression of disease. The tailoring of therapies based on findings from a biopsy after induction may improve outcomes.

Original languageEnglish (US)
Pages (from-to)981-986
Number of pages6
JournalPediatric Nephrology
Volume22
Issue number7
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

Keywords

  • Cyclophosphamide
  • Lupus nephritis
  • Outcome
  • Proliferative
  • Protocol biopsy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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    Askenazi, D., Myones, B., Kamdar, A., Warren, R., Perez, M., Guzman, M., Minta, A., Hicks, M. J., & Kale, A. S. (2007). Outcomes of children with proliferative lupus nephritis: The role of protocol renal biopsy. Pediatric Nephrology, 22(7), 981-986. https://doi.org/10.1007/s00467-007-0447-9