| Background and ObjectiveSystemic lupus erythematosus is an autoimmune disease that can involve multiple organs and systems.Lupus nephritis with children has a more rapid onset and progression than that in adults,and a worse prognosis.At present,the treatment of lupus nephritis in children is still controversial.Although some literatures have summarized the relationship between the clinical manifestations and pathological types of lupus nephritis in children,the sample size is relatively small and the study contents are not comprehensive enough to explain the correlation.We Collected the clinical,pathology,treatment and follow-up data of patients with lupus nephritis who were admitted to the Kidney Rheumatology Immunology Division of Shandong Provincial Hospital in the past 10 years,analysis the relationship with lupus nephritis in children between clinical features,pathological characteristics and treatment,and further analysis the effect of the treatment,the influence of the illness repeatedly,so as to provide reference for the diagnosis and treatment of patients with lupus nephritis in our region.MethodsRetrospective analysis on January 1,2009 to December 31,2018 in the Kidney Rheumatology Immunology Division of Shandong Provincial Hospital lead to the 107 cases with lupus nephritis,through the electronic medical record system to collect children early disease clinical data and pathological data and treatment in hospital,by telephone and WeChat inquiry,outpatient follow-up data collection way to follow-up of patients with lupus nephritis,full records obtained clinical data,treatment effect and repeatedly,will be more complete data sorting into EXCEL database.According to the initial clinical manifestations,the children were divided into the nephrotic lupus nephritis group and the non-nephrotic lupus nephritis group.The children were divided into complete remission group,partial remission group and non-remission group according to the treatment effect,and the children were divided into repeated group and non-repeated group according to whether the children had recurrent disease or not,and the differences in the clinical characteristics,pathological characteristics and treatment plan of each group were respectively compared.Finally,the independent risk factors affecting the prognosis of children with lupus nephritis were analyzedResults1.A total of 107 children with lupus nephritis were included,including 22 males and 85 females.The ratio of male to female was 1:3.86.2.Clinical features:the most common manifestation of renal symptoms was proteinuria in 104 patients(97.2%),of which 50%were large proteinuria and hematuria was also common,with a total of 85 patients(79.4%).The most common manifestations of extrarenal symptoms were anemia(75.7%),rash(74.8%),and fever(67.3%).The positive rate of ANA was 100%,and the positive rate of dsDNA antibody was up to 86.9%.Compared with non-NS LN children,the proportion of acute kidney injury and hypertension was higher(P<0.001)and the proportion of blood system involvement was lower(P=0.03).The difference was statistically significant.3.The pathological characteristic:the 107 cases of 75 renal biopsy in patients with lupus nephritis,the most common pathological types of diffuse type(Ⅳ),a total of 40 cases(53.3%),Proliferative LN was more likely to be combined with moderate to large proteinuria than non-proliferative LN(P<0.05),and the difference was statistically significant,the distribution of the clinical features and pathological type parallel relationship does not exist.4.Treatment:The most commonly used in the induction treatment phase was MMP combined with CTX shock 37.4%.In the first 5 years,50.0%were given MMP combined with CTX shock therapy,and in the last 5 years,MMF was selected for 33.3%.MMF was given to 60.4%of patients 5 years before and after maintenance treatment.The remission time of MMP+MMF was shorter than that of MMP+CTX(P<0.05),and the difference was statistically significant.The selection of MMP or immunosuppressive agents for different pathological types was different,proliferative LN was mainly followed by sequential oral MMF after MMP shock therapy,with a total of 15 cases(29.4%).5.Clinical outcome:the follow-up was terminated in June 2019,and 7 children lost follow-up,with a follow-up rate of 6.5%.By the end of the 107 patients with LN,88 had complete remission,12 had partial remission,5 had no remission,and 2 had death,with a total remission rate of 93.5%.Of the 98 children with complete follow-up data,72 had recurrent symptoms and 26 had no recurrent symptoms.6.Risk factor analysis:through multivariate logistic regression analysis,it was found that the independent risk factors affecting the prognosis of children with lupus nephritis in our center were 24hUPR.Through binary logistic regression analysis,it was found that the independent risk factors for the recurrence of lupus nephritis in children in our center were the age of onset and the time needed for remission.Conclusion1.Lupus nephritis mainly occurred in school-age females,with an average age of 10.35 ± 2.07 years.2.The clinical manifestations of lupus nephritis in children are diverse,with proteinuria and hematuria as the main manifestations of renal involvement,and anemia and rash as the main external symptoms.The comparison between NS type and non-NS type lupus nephritis shows that NS type lupus nephritis is more likely to be associated with acute kidney injury and high blood pressure,but less associated with blood system involvement.3.Children with lupus nephritis pathological types varied,the most common is class Ⅳ,proliferative LN tends to be associated with more proteinuria,no parallel relationship between clinical manifestation and pathological type.4.The most commonly used for induction therapy is MMP combined with CTX shock therapy,and the maintenance treatment phase is mainly MMF.MMP combined with CTX shock therapy was the most commonly used in the first 5 years,while MMF was more commonly used in the last 5 years.Proliferative LN was mainly given sequential oral MMF after MMP shock treatment.5.High 24UPR were independent risk factors for the prognosis.The older the onset,the longer the remission time is an independent risk factor for recurrent lupus nephritis in children at the center. |
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