Abstract: SA-PO688
Silent Lupus Nephritis vs. Overt Lupus Nephritis in a Pediatric Lupus Cohort
Session Information
- Pediatric Glomerular Disease
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1700 Pediatric Nephrology
Authors
- Mannemuddhu, Sai Sudha, University of Florida. College of Medicine., Gainesville, Florida, United States
- Borgia, Roberto Ezequiel, University of Florida. College of Medicine., Gainesville, Florida, United States
- Gupta, Nirupama, University of Florida- College of Medicine, Gainesville, Florida, United States
- Modica, Renee, Univeristy of Florida , Gainesville, Florida, United States
Background
Lupus nephritis (LN) is seen in 20–75% of childhood onset Systemic Lupus Erythematosus (cSLE) and is a predictor of poor prognosis. LN may present with active urinary sediment and/or renal impairment (overt LN- oLN) or be apparent only upon renal biopsy (silent LN-sLN). There is limited data regarding sLN in pediatric lupus. We describe and compare features of sLN and oLN.
Methods
Our retrospective review included patients followed at the University of Florida, Gainesville, diagnosed with cSLE < 18 years of age (≥ 4/11 ACR and/or ≥ 4/11 SLICC classification criteria) who underwent renal biopsy between January 2011 and October 2018. Continuous variables were compared using Student’s t test and categorical variables were compared using Fisher’s test.
Results
Out of 69 patients, 39% (n=27) were found to have sLN and 61% (n=42) had oLN. The most common histopathology [ISN/RPS] was Class II LN in sLN group (48%, n=13) and proliferative Class III/IV LN in oLN group (60%, n=25). However, 30% (n=8) of sLN had proliferative LN [Class III/IV]. The two groups had similar demographic features. Most of the patients were African American in both groups. There was no significant differences in C3, C4 levels and anti ds-DNA titers. Patients with oLN had more hypertension (p=0.01), deceased eGFR (p=0.03) and higher UPCR (p=0.002) when compared to sLN group. (refer to tables).
Conclusion
In our pediatric cohort, 39% were found to have sLN and 30% of them had proliferative LN, which was more prevalent in African American females with low C3. Renal biopsy should be considered in patients with very low C3 and before development of renal manifestations like hypertension, and decreased eGFR. However, more studies are needed to see if early diagnosis and treatment would modify the long-term renal outcomes.