Clinical Rheumatology

, Volume 23, Issue 4, pp 318–323 | Cite as

Retrospective analysis of the renal outcome of pediatric lupus nephritis

  • Li-Chieh Wang
  • Yao-Hsu Yang
  • Meng-Yao Lu
  • Bor-Luen Chiang
Original Article


The aim of this study was to analyze the renal outcome of pediatric lupus nephritis in the past two decades. We retrospectively reviewed the medical records of patients who fulfilled the 1987 American Rheumatism Association revised criteria for systemic lupus erythematosus who were followed up at the National Taiwan University Hospital between 1980 and 2001. All new patients who were under 18 years of age at the time of diagnosis were enrolled and were followed up until death, loss to follow-up, or till the end of 2002. The response to the treatment and renal outcome were analyzed. Seventy-two children (64 girls and 8 boys) were enrolled in the study. The mean age at diagnosis was 13.93±0.35 years (mean ± SEM). The mean duration of follow-up was 7.12±0.51 years. The 5-year renal survival rate (survival without dialysis or transplantation) was 63.13% and the 10-year survival rate was 53.54%. It was significantly better in patients receiving cyclophosphamide (CYC) pulse therapy. The 5-year survival rate for these patients was 87.82% and the 10-year survival rate was 81.06%. The renal survival curve was better in the CYC pulse therapy group than in the no CYC pulse therapy group, with p=0.0022. The duration between the diagnosis of lupus nephritis and end-stage renal disease (ESRD) was significantly longer in the CYC group (9.66±1.32 yrs) than in the no CYC group (3.24±0.94 yers), p=0.036. In the multivariate analysis, risk factors of developing ESRD were failure to achieve complete remission, higher serum creatinine at the initiation of treatment, and not receiving CYC pulse therapy. The renal survival was significantly better in the CYC pulse therapy group. The CYC pulse therapy was recommended in pediatric lupus nephritis patients and every effort should be made to achieve complete remission.


Cyclophosphamide pulse therapy End-stage renal disease Lupus nephritis Systemic lupus erythematosus 





End-stage renal disease


High-power field




Systemic lupus erythematosus


  1. 1.
    Cervera R, Khamashta MA, Font J et al. (1993) Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1000 patients. Medicine (Baltimore) 72:113–124Google Scholar
  2. 2.
    Baqi N, Moazami S, Singh A, Ahmad H, Balachandra S, Tejani A (1996) Lupus nephritis in children: a longitudinal study of prognostic factors and therapy. J Am Soc Nephrol 7:924–929Google Scholar
  3. 3.
    Huong DLT, Papo T, Beaufils H et al. (1999) Renal involvement in systemic lupus erythematosus: a study of 180 patients from a single center. Medicine 78:148–166CrossRefPubMedGoogle Scholar
  4. 4.
    Merrell M, Shulman LE (1995) Determination of prognosis in chronic disease illustrated by systemic lupus erythematosus. J Chronic Dis 1:12–32CrossRefGoogle Scholar
  5. 5.
    MacGowan JR, Ellis S, Griffiths M, Isenberg DA (2002) Retrospective analysis of outcome in a cohort of patients with lupus nephritis treated between 1977 and 1999. Rheumatology 41:981–987CrossRefPubMedGoogle Scholar
  6. 6.
    Illei GG, Takada K, Parkin D et al. (2002) Renal flares are common in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy. Arthritis Rheum 46:995–1002Google Scholar
  7. 7.
    Yan DC, Chou CC, Tsai MJ, Chiang BL, Tsau YK, Hsieh KH (1995) Intravenous cyclophosphamide pulse therapy on children with severe active lupus nephritis. Acta Paed Sin 36:203–209Google Scholar
  8. 8.
    Gladman DD, Ibanez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29:288–291PubMedGoogle Scholar
  9. 9.
    Mok CC, Wong RWS, Lau CS (1999) Lupus nephritis in Southern Chinese patients: clinicopathologic findings and long-term outcome. Am J Kidney Dis 34:315–323PubMedGoogle Scholar
  10. 10.
    Wang LC, Yang YC, Lu MY, Chiang BL (2003) Retrospective analysis of mortality and morbidity of pediatric systemic lupus erythematosus in the past two decades. J Microbiol Immunol Infect 36:203–208PubMedGoogle Scholar
  11. 11.
    Clark WF, Moist LM (1998) Management of chronic renal insufficiency in lupus nephritis: role of proteinuria, hypertension and dyslipidemia in the progression of renal disease. Lupus 7:649–653CrossRefPubMedGoogle Scholar
  12. 12.
    Austin HA, Boumpas DT, Vaughan DM, Balow JE (1995) High-risk features of lupus nephritis: importance of race and clinical and histological factors in 166 patients. Nephrol Dial Transplant 10:1620–1628PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2004

Authors and Affiliations

  • Li-Chieh Wang
    • 1
  • Yao-Hsu Yang
    • 1
  • Meng-Yao Lu
    • 1
  • Bor-Luen Chiang
    • 1
  1. 1.Department of PediatricsNational Taiwan University HospitalTaipeiTaiwan, ROC

Personalised recommendations