Abstract
AimTo study the various pathological patterns of pediatric lupus nephritis (LN) by renal biopsies and to correlate the histopathological data with the clinical and biochemical outcomes.MethodsThis is a retrospective study in children between 1 month and 18 years of age with renal biopsy-proven lupus nephritis, conducted between January 2015 and December 2019. Various pathological and clinical parameters were compared between the groups with lupus nephritis activity and those without activity.ResultsOf 38 biopsy-proven lupus nephritis cases, 30 (78.9%) were in the adolescent age group, and the female gender was predominantly affected (n=30; 78.9%). Class IV proliferative lupus nephritis (n=17, 44.7%) was the most common biopsy finding, and the activity score for endocapillary hypercellularity, neutrophil infiltration, fibrinoid necrosis, hyaline deposits, and interstitial inflammation was significantly high in classes III and IV. Overall, attaining remission was less, and the risk of progression of chronic kidney disease (CKD) was higher in class IV (n=3; 7.8%). Mortality was reported in 1 out of 38 (2.6%) children.ConclusionLight microscopy and immunofluorescence studies play an important role in defining the extent of renal damage in the form of activity and chronicity indices, which are the key factors in the decision-making of lupus nephritis treatment. The prognostic relevance of the histological scoring has been evaluated, and it is evident that the activity index and chronicity index go a long way in therapeutic intervention.
Highlights
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease
Class IV proliferative lupus nephritis (n=17, 44.7%) was the most common biopsy finding, and the activity score for endocapillary hypercellularity, neutrophil infiltration, fibrinoid necrosis, hyaline deposits, and interstitial inflammation was significantly high in classes III and IV
Light microscopy and immunofluorescence studies play an important role in defining the extent of renal damage in the form of activity and chronicity indices, which are the key factors in the decision-making of lupus nephritis treatment
Summary
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. The crude incidence rate ranges from 0.9 to 3.1 (per 100,000 per year) across Asia-Pacific countries, while the prevalence rate ranges between 4.3 and 45.3 (per 100,000 per year) [1]. In SLE, patients who develop lupus nephritis (LN) present at a younger age than patients without nephritis [2]. In pediatric patients with SLE, one of the most common organs involved is the kidneys. Previous studies have shown that up to 80% of children with SLE eventually develop nephritis. They may either present with overt renal symptoms at the time of diagnosis (21-65%) or during the course of their illness (40-82%) [1]
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