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Background Renal involvement during the clinical course of
systemic lupus erythematosus (SLE) is generally considered to be
the most important factor influencing disease prognosis in terms
of morbidity and mortality. Various factors have been reported to
influence the prognosis of lupus nephritis (LN).
Objective To analyze clinical signs and laboratory parameters that
might serve as predictors associated with mortality in pediatric
Methods Retrospectively, medical records of children with LN
at Soetomo Hospital from 1998 to 2011 were studied. Diagnosis
of SLE was based on Revised American Rheumatism Association
critera, while patients with clinical manifestations of hypertension,
abnormal urinalysis, and serum creatinin > 1 mg/dL were
considered as lupus nephritis. Cox proportional hazard modeling
was used to assess for associations of clinical signs and laboratory
parameters with mortality. Kaplan-Meier survival analysis was
used to assess the cumulative survival from the time of diagnosis
to the outcome.
Results There were 57 children with LN of whom 43 (75%) were
girls. The female-to-male ratio was 3:1. Subjects’ mean age was 10.6
(SD 6.87) years. The mean time of observation was 51 (SD 74.54)
months and 23 (40%) children died. Age, gender, hypertension,
hematuria, proteinuria, and anemia were not significant as
predictors for mortality. However, hypertensive crisis (HR=2.79;
95%CI 1.16 to 6.75; P=0.02) and initial glomerular filtration rate
(GFR) of <75 mL/min/1.73m2 (HR=3.01; 95%CI 1.23 to 7.34;
P=0.01) were significant predictors of mortality in children with LN.
The mean survival time of LN with hypertensive crisis and initial
GFR <75 mL/min/1.73m2 was 36.9 (SD 12.17) months.
Conclusion Hypertensive crisis and GFR <75 mL/min/1.73m2 are
significant predictors of mortality in children with LN.
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2. Annavarajula SK, Murty KV, Prayaga A, Das U, Desai M, Narain CA. The outcome of proliferative lupus nephritis with pulse cyclophosphamide therapy. Indian J Nephrol. 2011;21:160-5.
3. Stichweh D, Arce E, Pascual V. Update on pediatric systemic lupus erythmatosus. Curr Opin Rheumatol. 2004;16:577–87.
4. Perfumo F, Martini A. Lupus nephritis in children. Lupus. 2005;14:83–8.
5. Gibson KL, Gipson DS, Massengill SA, Dooley MA, Primack WA, Ferris MA, et al. Predictors of relapse and end stage kidney disease in proliferative lupus nephritis: focus on children, adolescents, and young adults. Clin J Am Soc Nephrol. 2009;4:1962-7.
6. Emre S, Bilge I, Sirin A, Kiricaslan I, Nayir A, Oktem F, et al. Lupus nephritis in children: prognostic significance of clinicopathological findings. Nephron. 2001;87:118-26.
7. Mok CC, Ying KY, Tang S, Leung CY, Lee KW, Ng WL, et al. Predictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis. Arthritis Rheum. 2004;50:2559-68.
8. American College of Rheumatology Criteria for Classification of Systemic Lupus Erythematosus. Downloaded from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0041704.
9. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004;15:241-50 (Errata: 835-6).
10. Ataei N, Haydarpour M, Madani A, Esfahani ST, Hajizadeh N, Moradinejad MH, et al. Outcome of lupus nephritis in Iranian children: prognostic significance of certain features. Pediatr Nephrol. 2008;23:749-55.
11. Ahmadzadeh A, Derakhshan A, Ahmadzadeh A. A clinicopathological study of lupus nephritis in children. Saudi J Kidney Dis Transpl. 2008;19:756-60.
12. Nezhad ST, Sepaskhah R. Correlation of clinical and pathological findings in patients with lupus nephritis: a five-year experience in Iran. Saudi J Kidney Dis Transpl. 2008;19:32-40.
13. Hagelberg S, Lee Y, Bargman J, Mah G, Schneider R, Laskin C, et al. Longterm follow up of childhood lupus nephritis. J Rheumatol. 2002;29:2635-42.
14. Font J, Cervera R, Espinosa G, Pallares L, Ramos-Casals M, Jimenez S, et al. Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparisons with SLE characteristics in adults. Ann Rheum Dis. 1998;57:456-9.
15. McCurdy DK, Lehman TJ, Bernstein B, Hanson V, King KK, Nadorra R, et al. Lupus nephritis: prognostic factors in children. Pediatrics. 1992;89:240-6.
16. Perfume F, Martini A. Lupus nephritis in children. Lupus. 2005;14:83-8.
17. Austin HA, Boumpas DI, Vaughen EM, Balow JE. Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data. Kidney Int. 1994;45:544-50.
18. Gloor J. Lupus nephritis in children. Lupus. 1998;7:639-43.
19. Esdalle JM, Federgreen W, Quintal H, Suissa S, Hayslett JP, Kashgarian M. Predictors of one year outcome in lupus nephritis: the importance of renal biopsy. Q J Med. 1991;81:907-18.
20. Martins L, Rocha G, Rodrigues A, Santos J, Vasconcelos C, Correia J, et al. Lupus nephritis: a retrospective review of 78 cases from single center. Clin Nephrol. 2002;57:114-9.