SAT-413 LUPUS NEPHRITIS IN CHILDREN AND ADULTS FROM A RESOURCE LIMITED SETTING- A CLINICOPATHOLOGICAL COMPARISON

Abstract

Childhood-onset systemic lupus erythematosus (SLE) differs from adult-onset disease in important ways especially renal manifestations. Pediatric Lupus Nephritis (ped LN) which is 30% more prevalent, causes significant morbidity and mortality. In general, treatment for ped LN is based on standard approaches in adults with Lupus Nephritis, because of the lack of large randomized trials in pediatric disease regarding the appropriate drug doses and treatment duration for children who have longer life expectancy and has the concerns of growth and development. Hence we aimed to compare the clinicopathological profile and response to induction treatment in ped LN with that of adults. Data was collected from 36 cases of ped LN and 55 adult LN cases from the year 2010 to 2016 (7 years). Clinicopathological findings at the time of presentation were noted. Renal biopsies were reported by the same renal pathologist and ISN/RPS (2003) classification was followed. The Activity Index (AI) and Chronicity Index (CI) were calculated using NIH scoring system. All patients received treatment as per NIH protocol. The correlation between clinical features, class of lupus nephritis, morphological indices and response to induction treatment in childhood lupus nephritis was assessed and compared in both the groups. Among 36 pediatric patients, 75% were females. 33.33% had nephrotic range proteinuria and 5.56 % had no proteinuria.63.9% had hematuria and 36.1 % had pyuria. Majority had proliferative lupus nephritis Class III- 41.67%, Class Iv- 44.44%). Mean AI was 5.4 (range (0 to 16). Majority were not having any chronicity. ( mean CI-0.33; Range - 0-3). Children who attained complete remission following 6 months induction treatment(n=25), had a mean AI of 4.98 while those who had only partial/no remission had a mean of 6.09. Out of 55 adults, Class IV was the commonest type and the mean AI was 7.83 and mean CI was 2.04. Patients who attained complete remission (n=30) had a mean AI of 7.15 and mean CI of 1.54. where as those adults who had only partial /no remission had higher mean AI (8.88) and CI (2.6) Though the distribution of major classes of LN were similar in both adults and children, ped LN has lesser activity and minimal or nil chronicity compered to adults. Morphological indices in renal biopsy are useful in predicting response to induction treatment. The finding of more chance of attaining complete remission in ped LN compared to adult LN needs validation in future larger studies.