Abstract: SA-PO244

Male Pediatric Lupus Nephritis Patients Experience Greater Mortality but Less Progression to ESKD

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Benefield, Halei, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Jobson, Meghan A., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Baldwin, Anna Lane, University of North Carolina School of Medicine , Chapel Hill, North Carolina, United States
  • Wu, Eve, The University of North Carolina, Chapel Hill, North Carolina, United States
  • Pendergraft, William Franklin, University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States
  • Gibson, Keisha L., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States
Background

Epidemiological data on pediatric lupus nephritis are lacking. Here we present characteristics and outcomes of a racially diverse cohort of pediatric lupus nephritis patients.

Methods

We evaluated disease history and outcomes of patients age ≤ 19 years with tissue read by the UNC Nephropathology department as biopsy-proven lupus nephritis. Primary outcomes were end-stage kidney disease (ESKD) and death. Secondary outcomes included kidney transplant and adverse events per years of follow-up. Univariate logistic regression was used to calculate odds ratios and 95% confidence intervals with race (black or white) and sex coded as dichotomous categorical variables.

Results

Of 87 patients identified, 52 (60%) were female, 54 (62%) were black, 21 (24%) were white, and 12 (14%) were other. The mean follow-up duration was 11.6 years (SD 8.0). At diagnosis, 80% of patients presented with renal involvement, 59% with cutaneous symptoms, and 43% with hematological manifestations. The median age at biopsy was 14.6 years (IQR: 12.4, 17.2). 17 patients (20%) died with a median age at death of 20.8 years (18.9, 24.7). 18 patients (21%) progressed to ESKD with a median time to ESKD from first biopsy of 5.1 years (1.9, 7.4). Four patients (5%) underwent kidney transplant. Black patients experienced a median of 1.1 (0.4, 3.4) adverse events per 5 years of follow-up versus 0.6 (0.4, 1.2) in white patients; male patients experienced 0.6 (0.4, 1.7) events versus 1.6 (0.5, 4.0) in female patients. Black patients had 1.7 times the odds of death (95% CI: 0.4, 6.8) and 3.0 times the odds of ESKD (0.6, 14.7) compared to white patients. Male patients had 1.4 times the odds of death (0.5, 4.1) but 0.2 times the odds of ESKD (0.06, 0.9) as compared to female patients.

Conclusion

Our findings suggest that black pediatric patients with lupus nephritis have higher morbidity and mortality than white patients and that male patients have higher mortality but less renal morbidity than female patients. Longer follow-up and continued cohort enrollment will be important to broaden our knowledge of pediatric lupus nephritis.