Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus

Ina Kazyra; Alexander Sukalo

doi:doi:10.11648/j.ajp.20200601.15

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Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus

Ina Kazyra, Alexander Sukalo

Published in American Journal of Pediatrics (Volume 6, Issue 1)

Received: 15 January 2020 Accepted: 10 February 2020 Published: 18 February 2020

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Abstract

The article presents a historical and prospective analysis of the clinical and paraclinical data of a cohort of children suffering from systemic lupus erythematosus (SLE) with kidney damage, observed in a single center for 21 year. The case histories of 62 patients (51 girls and 11 boys) with a diagnosis of SLE and lupus nephritis (LN) who were monitored and treated at the Byelorussian Center for Pediatric Nephrology and Renal Replacement Therapy of the 2nd Children's Clinical Hospital in Minsk in the period from 1998 to 2019 yrs. We evaluated the initial manifestations of the disease, age of the onset, time of diagnosis (from the first symptom to the diagnosis), clinical manifestations at the time of diagnosis, the duration of SLE and treatment at the time of kidneys biopsy, as well as the activity of the disease. During the observation period (from 3 months up to 12 years) the frequency of extrarenal and renal exacerbations was analyzed, and the activity, treatment and outcome were evaluated. Male gender and early debut are factors worsening the prognosis of the disease (55% of boys showed progression of CRF). In children, the disease proceeds with a high degree of activity, rapid multi-organ involvement, requires more aggressive therapy with prescription of several immunosuppressive agents, which increases the risk of infection. Nephritis is an unfavorable prognostic criterion and is crucial in determining the volume of therapy for SLE. Noncompliance in therapy, social status were factors of an unfavorable outcome in children. Timely diagnosis and aggressive intervention to suppress the activity of the disease should be used to prevent chronic irreversible damage. Children with SLE and kidney damage are at high risk for early development of cardiovascular disorders. Steroid-sparing strategies must be actively implemented in clinical practice in order to prevent severe side effects.

Published in	American Journal of Pediatrics (Volume 6, Issue 1) This article belongs to the Special Issue Chronic Kidney Disease in Children
DOI	10.11648/j.ajp.20200601.15
Page(s)	31-36
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Systemic Lupus Erythematosus, Lupus Nephritis, Children

References

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[2]	Thakur N, Rai N, Batra P. Pediatric Lupus Nephritis-Review of Literature. Curr Rheumatol Rev. 2017; 13 (1): 29-36. doi: 10.2174/1573397112666160404124308.
[3]	Sousa S, Goncalves MJ, Ines LS, Eugenio G, Jesus D, Fernandes S, et al. Clinical features and long-term outcomes of systemic lupus erythematosus: comparative data of childhood, adult and late-onset disease in a national register. Rheumatol Int. (2016) 36: 955–60. 10.1007/s00296-016-3450-2.
[4]	Pusongchai T, Jungthirapanich J, Khositseth S. Pediatric systemic lupus erythematosus in Thammasat University Hospital. J Med Assoc Thail. (2010) 93 (Suppl 7): S283–93.
[5]	Hartman EAR, van Royen-Kerkhof A, Jacobs JWG, Welsing PMJ, Fritsch-Stork RDE. Performance of the 2012 Systemic Lupus International Collaborating Clinics classification criteria versus the 1997 American College of Rheumatology classification criteria in adult and juvenile systemic lupus erythematosus. A systematic review and meta-analysis. Autoimmun Rev. 2018 Mar; 17 (3): 316-322. doi: 10.1016/j.autrev.2018.01.007. Epub 2018 Jan 31.
[6]	Almaani S, Meara A, Rovin BH. Update on Lupus Nephritis. Clin J Am Soc Nephrol. 2017 May 8; 12 (5): 825-835. doi: 10.2215/CJN.05780616. Epub 2016 Nov 7.
[7]	Tan JH, Hoh SF, Win MT, Chan YH, Das L, Arkachaisri T. Childhood-onset systemic lupus erythematosus in Singapore: clinical phenotypes, disease activity, damage, and autoantibody profiles. Lupus (2015) 24: 998–1005. 10.1177/0961203315584413.
[8]	Sebastiani GD, Prevete I, Piga M, Iuliano A, Bettio S, Bortoluzzi A, et al. Early lupus project - A multicentre Italian study on systemic lupus erythematosus of recent onset. Lupus (2015) 24: 1276–82. 10.1177/0961203315585817.
[9]	Taddio A, Rossetto E, Rose CD, Brescia AM, Bracaglia C, Cortis E, et al. Prognostic impact of atypical presentation in pediatric systemic lupus erythematosus: results from a multicenter study. J Pediatr. (2010) 156: 972–7. 10.1016/j.jpeds.2009.12.022.
[10]	Hiraki LT, Benseler SM, Tyrrell PN, Hebert D, Harvey E, Silverman ED. Clinical and laboratory characteristics and long-term outcome of pediatric systemic lupus erythematosus: a longitudinal study. J Pediatr. (2008) 152: 550–6. 10.1016/j.jpeds.2007.09.019.
[11]	Quinlan C, Marks SD, Tullus K. Why are kids with lupus at an increased risk of cardiovascular disease? Pediatr Nephrol. 2016 Jun; 31 (6): 861-83. doi: 10.1007/s00467-015-3202-7. Epub 2015 Sep 23.
[12]	Rianthavorn P, Prurapark P. Risk factors of infection-associated mortality in children with lupus nephritis in under-resourced areas. Lupus. 2019 Dec; 28 (14): 1727-1734. doi: 10.1177/0961203319882498. Epub 2019 Oct 21.
[13]	Ardoin SP, Daly RP, Merzoug L, Tse K et al. Research priorities in childhood-onset lupus: results of a multidisciplinary prioritization exercise. Pediatr Rheumatol Online J. 2019 Jul 1; 17 (1): 32. doi: 10.1186/s12969-019-0327-4.
[14]	Pinheiro SVB, Dias RF, Fabiano RCG, Araujo SA, Silva ACSE. Pediatric lupus nephritis. J Bras Nefrol. 2019 Apr-Jun; 41 (2): 252-265. doi: 10.1590/2175-8239-JBN-2018-0097. Epub 2018 Nov 14.
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APA Style

Ina Kazyra, Alexander Sukalo. (2020). Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus. American Journal of Pediatrics, 6(1), 31-36. https://doi.org/10.11648/j.ajp.20200601.15

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ACS Style

Ina Kazyra; Alexander Sukalo. Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus. Am. J. Pediatr. 2020, 6(1), 31-36. doi: 10.11648/j.ajp.20200601.15

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AMA Style

Ina Kazyra, Alexander Sukalo. Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus. Am J Pediatr. 2020;6(1):31-36. doi: 10.11648/j.ajp.20200601.15

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@article{10.11648/j.ajp.20200601.15,
  author = {Ina Kazyra and Alexander Sukalo},
  title = {Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus},
  journal = {American Journal of Pediatrics},
  volume = {6},
  number = {1},
  pages = {31-36},
  doi = {10.11648/j.ajp.20200601.15},
  url = {https://doi.org/10.11648/j.ajp.20200601.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20200601.15},
  abstract = {The article presents a historical and prospective analysis of the clinical and paraclinical data of a cohort of children suffering from systemic lupus erythematosus (SLE) with kidney damage, observed in a single center for 21 year. The case histories of 62 patients (51 girls and 11 boys) with a diagnosis of SLE and lupus nephritis (LN) who were monitored and treated at the Byelorussian Center for Pediatric Nephrology and Renal Replacement Therapy of the 2nd Children's Clinical Hospital in Minsk in the period from 1998 to 2019 yrs. We evaluated the initial manifestations of the disease, age of the onset, time of diagnosis (from the first symptom to the diagnosis), clinical manifestations at the time of diagnosis, the duration of SLE and treatment at the time of kidneys biopsy, as well as the activity of the disease. During the observation period (from 3 months up to 12 years) the frequency of extrarenal and renal exacerbations was analyzed, and the activity, treatment and outcome were evaluated. Male gender and early debut are factors worsening the prognosis of the disease (55% of boys showed progression of CRF). In children, the disease proceeds with a high degree of activity, rapid multi-organ involvement, requires more aggressive therapy with prescription of several immunosuppressive agents, which increases the risk of infection. Nephritis is an unfavorable prognostic criterion and is crucial in determining the volume of therapy for SLE. Noncompliance in therapy, social status were factors of an unfavorable outcome in children. Timely diagnosis and aggressive intervention to suppress the activity of the disease should be used to prevent chronic irreversible damage. Children with SLE and kidney damage are at high risk for early development of cardiovascular disorders. Steroid-sparing strategies must be actively implemented in clinical practice in order to prevent severe side effects.},
 year = {2020}
}

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TY  - JOUR
T1  - Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus
AU  - Ina Kazyra
AU  - Alexander Sukalo
Y1  - 2020/02/18
PY  - 2020
N1  - https://doi.org/10.11648/j.ajp.20200601.15
DO  - 10.11648/j.ajp.20200601.15
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20200601.15
AB  - The article presents a historical and prospective analysis of the clinical and paraclinical data of a cohort of children suffering from systemic lupus erythematosus (SLE) with kidney damage, observed in a single center for 21 year. The case histories of 62 patients (51 girls and 11 boys) with a diagnosis of SLE and lupus nephritis (LN) who were monitored and treated at the Byelorussian Center for Pediatric Nephrology and Renal Replacement Therapy of the 2nd Children's Clinical Hospital in Minsk in the period from 1998 to 2019 yrs. We evaluated the initial manifestations of the disease, age of the onset, time of diagnosis (from the first symptom to the diagnosis), clinical manifestations at the time of diagnosis, the duration of SLE and treatment at the time of kidneys biopsy, as well as the activity of the disease. During the observation period (from 3 months up to 12 years) the frequency of extrarenal and renal exacerbations was analyzed, and the activity, treatment and outcome were evaluated. Male gender and early debut are factors worsening the prognosis of the disease (55% of boys showed progression of CRF). In children, the disease proceeds with a high degree of activity, rapid multi-organ involvement, requires more aggressive therapy with prescription of several immunosuppressive agents, which increases the risk of infection. Nephritis is an unfavorable prognostic criterion and is crucial in determining the volume of therapy for SLE. Noncompliance in therapy, social status were factors of an unfavorable outcome in children. Timely diagnosis and aggressive intervention to suppress the activity of the disease should be used to prevent chronic irreversible damage. Children with SLE and kidney damage are at high risk for early development of cardiovascular disorders. Steroid-sparing strategies must be actively implemented in clinical practice in order to prevent severe side effects.
VL  - 6
IS  - 1
ER  -

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Author Information

Ina Kazyra

Department of Pediatrics, Belarus State Medical University, Minsk, Republic of Belarus
Alexander Sukalo

Department of Pediatrics, Belarus State Medical University, Minsk, Republic of Belarus

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APA Style

Ina Kazyra, Alexander Sukalo. (2020). Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus. American Journal of Pediatrics, 6(1), 31-36. https://doi.org/10.11648/j.ajp.20200601.15

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ACS Style

Ina Kazyra; Alexander Sukalo. Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus. Am. J. Pediatr. 2020, 6(1), 31-36. doi: 10.11648/j.ajp.20200601.15

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AMA Style

Ina Kazyra, Alexander Sukalo. Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus. Am J Pediatr. 2020;6(1):31-36. doi: 10.11648/j.ajp.20200601.15

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@article{10.11648/j.ajp.20200601.15,
  author = {Ina Kazyra and Alexander Sukalo},
  title = {Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus},
  journal = {American Journal of Pediatrics},
  volume = {6},
  number = {1},
  pages = {31-36},
  doi = {10.11648/j.ajp.20200601.15},
  url = {https://doi.org/10.11648/j.ajp.20200601.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20200601.15},
  abstract = {The article presents a historical and prospective analysis of the clinical and paraclinical data of a cohort of children suffering from systemic lupus erythematosus (SLE) with kidney damage, observed in a single center for 21 year. The case histories of 62 patients (51 girls and 11 boys) with a diagnosis of SLE and lupus nephritis (LN) who were monitored and treated at the Byelorussian Center for Pediatric Nephrology and Renal Replacement Therapy of the 2nd Children's Clinical Hospital in Minsk in the period from 1998 to 2019 yrs. We evaluated the initial manifestations of the disease, age of the onset, time of diagnosis (from the first symptom to the diagnosis), clinical manifestations at the time of diagnosis, the duration of SLE and treatment at the time of kidneys biopsy, as well as the activity of the disease. During the observation period (from 3 months up to 12 years) the frequency of extrarenal and renal exacerbations was analyzed, and the activity, treatment and outcome were evaluated. Male gender and early debut are factors worsening the prognosis of the disease (55% of boys showed progression of CRF). In children, the disease proceeds with a high degree of activity, rapid multi-organ involvement, requires more aggressive therapy with prescription of several immunosuppressive agents, which increases the risk of infection. Nephritis is an unfavorable prognostic criterion and is crucial in determining the volume of therapy for SLE. Noncompliance in therapy, social status were factors of an unfavorable outcome in children. Timely diagnosis and aggressive intervention to suppress the activity of the disease should be used to prevent chronic irreversible damage. Children with SLE and kidney damage are at high risk for early development of cardiovascular disorders. Steroid-sparing strategies must be actively implemented in clinical practice in order to prevent severe side effects.},
 year = {2020}
}

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TY  - JOUR
T1  - Lupus Nephritis in Children: 21-Year Experience of a Single Center in Belarus
AU  - Ina Kazyra
AU  - Alexander Sukalo
Y1  - 2020/02/18
PY  - 2020
N1  - https://doi.org/10.11648/j.ajp.20200601.15
DO  - 10.11648/j.ajp.20200601.15
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20200601.15
AB  - The article presents a historical and prospective analysis of the clinical and paraclinical data of a cohort of children suffering from systemic lupus erythematosus (SLE) with kidney damage, observed in a single center for 21 year. The case histories of 62 patients (51 girls and 11 boys) with a diagnosis of SLE and lupus nephritis (LN) who were monitored and treated at the Byelorussian Center for Pediatric Nephrology and Renal Replacement Therapy of the 2nd Children's Clinical Hospital in Minsk in the period from 1998 to 2019 yrs. We evaluated the initial manifestations of the disease, age of the onset, time of diagnosis (from the first symptom to the diagnosis), clinical manifestations at the time of diagnosis, the duration of SLE and treatment at the time of kidneys biopsy, as well as the activity of the disease. During the observation period (from 3 months up to 12 years) the frequency of extrarenal and renal exacerbations was analyzed, and the activity, treatment and outcome were evaluated. Male gender and early debut are factors worsening the prognosis of the disease (55% of boys showed progression of CRF). In children, the disease proceeds with a high degree of activity, rapid multi-organ involvement, requires more aggressive therapy with prescription of several immunosuppressive agents, which increases the risk of infection. Nephritis is an unfavorable prognostic criterion and is crucial in determining the volume of therapy for SLE. Noncompliance in therapy, social status were factors of an unfavorable outcome in children. Timely diagnosis and aggressive intervention to suppress the activity of the disease should be used to prevent chronic irreversible damage. Children with SLE and kidney damage are at high risk for early development of cardiovascular disorders. Steroid-sparing strategies must be actively implemented in clinical practice in order to prevent severe side effects.
VL  - 6
IS  - 1
ER  -

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