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Abstract
Background and aims There is no class I evidence available to treat children with lupus nephritis (LN). This study looked at our experience of management of LN and contribute to the existing world literature. In addition to treatment of LN, care is given to educate the family, manage lipids, BMI, restricting steroid use to 1 mg/kg/day at onset, give hydroxychloroquine to all and vaccinate if possible.
To study the clinical profile and lab parameters of children at onset of nephritis.
To see which of the two drugs cyclophosphamide(CYC) or mycophenolate mofetil (MMF)were more effective by studying the time to renal flare.
To analyse the side effects and disease related damage in these children
Methods All children with lupus nephritis who attended the Paediatric Rheumatology clinic from Sept 2009 to Sept 2016 were included.
Results 166 children with SLE, 67 had LN 67/166 (40.3%); Male: Female=1: 2.72. Median SLEDAI at nephritis onset:18 57 renal biopsies:Class I:1, Class II:5, Class III:19, Class IV:26, Class V:6 MMF used to induce remission:43(64%), Cyclophosphamide (CYC) 19 (28%) Azathioprine:5(7%). 67% achieved complete remission during induction. 25% partial remission/flared after an initial response within induction period. Median time to response during induction therapy: 4 months (2–17 months). MMF was given to 82% and Azathioprine to 18% for maintenance. 36/62 (58%) never flared, 23/62 (37%) flared during induction therapy and 3/62 (5%) were in partial remission.
Basic demographics.
Outcome variables.
The primary outcome measure, time to renal flare was statistically insignificant regardless of the induction agent used
Kaplan Meir survival curve: Median time to flare with Drug1 (MMf) 91 months as induction agent vs 101 months with drug 2(CYC) and 48 months with drug 3(Aza)
Conclusions MMF and CYC were equally effective as induction agents and neither was superior to prevent renal flares. No factor: demographic, clinical or laboratory could predict renal flares. 58% were in renal remission, 33% on steroids.