Development of clinical and laboratory biomarkers in an international cohort of 428 children with lupus nephritis.

Abstract

Lupus nephritis (LN) is a very severe manifestation of lupus. There is no consensus on which treatment goals should be achieved to protect kidney function in children with LN. We retrospectively analyzed trends of commonly used laboratory biomarkers of 428 patients (≤ 18years old) with biopsy-proven LN class ≥ III. We compared data of patients who developed stable kidney remission from 6 to 24months with those who did not. Twenty-five percent of patients maintained kidney stable remission while 75% did not. More patients with stable kidney remission showed normal hemoglobin and erythrocyte sedimentation rate from 6 to 24months compared to the group without stable kidney remission. eGFR ≥ 90ml/min/1.73m2 at onset predicted the development of stable kidney remission (93.8%) compared to 64.7% in those without stable remission (P < 0.00001). At diagnosis, 5.9% and 20.2% of the patients showed no proteinuria in the group with and without stable kidney remission, respectively (P = 0.0001). dsDNA antibodies decreased from onset of treatment mainly during the first 3months in all groups, but more than 50% of all patients in both groups never normalized after 6months. Complement C3 and C4 increased mainly in the first 3months in all patients without any significant difference. Normal eGFR and the absence of proteinuria at onset were predictors of stable kidney remission. Significantly more children showed normal levels of Hb and erythrocyte sedimentation rate (ESR) from 6 to 24months in the group with stable kidney remission.