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Epidemiology treatment and outcome of childhood systemic lupus erythematosus in Egypt

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Abstract

To highlight the characteristics of Egyptian children with systemic lupus erythematosus (SLE), the records of 52 SLE patients (48 girls and four boys aged 11.9±2.6 years) were retrospectively analyzed. The median duration of follow up was 22 months (range 1–94.5). The most common extrarenal manifestation was fever (76.6%), followed by joint involvement (65.4%). Hemolytic anemia was demonstrated in 51%, thrombocytopenia in 29.2%, and leucopenia in 27.5%. Antinuclear antibodies were positive in 92.7%, while positive anti-double-stranded DNA and hypocomplementemia were demonstrated in 95.6% and 67.4%, respectively. Lupus nephritis (LN) was evident in 80.8%. The renal manifestations of LN patients were proteinuria (83.3%), hematuria (71.5%), hypertension (35.7%), and elevated serum creatinine (16.7%). The histopathological findings of the initial renal biopsies were class I (4.9%), class II (22%), class III (36.3%), and class IV (36.3%). Among patients without LN, 85.7% gained remission and nonimmediately died. At last observation, 55.6% of LN patients had complete remission, 22.2% had active disease, and 22.2% died. Most patients who died had class IV LN. In conclusion, the characteristics of Egyptian SLE children are comparable with those in most Arab and Western series. However, LN may be more prevalent and severe, with unfavorable outcomes.

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References

  1. Estes D, Christian C (1971) The natural history of systemic lupus erythematosus. Medicine (Baltimore) 50:85–89

  2. Lehman TJA, McCurdy DK, Bernstein BH, King KK, Hanson V (1989) Systemic lupus erythematosus in the first decade of life. Pediatrics 83:235–239

    CAS  PubMed  Google Scholar 

  3. Platt JL, Burke BA, Fish AJ, Kim Y, Michael AF (1982) Systemic lupus erythematosus in the first two decades of life. A J Kidney Dis 2:212–222

    CAS  Google Scholar 

  4. Barron KS, Silverman ED, Gonzales J, Reveille JD (1993) Clinical, serologic, and immunogenetic studies in childhood-onset systemic lupus erythematosus. Arthritis Rheum 36:348–354

    CAS  PubMed  Google Scholar 

  5. Gloor JM (1998) Lupus nephritis in children. Lupus 7:639–643

    CAS  PubMed  Google Scholar 

  6. Lang BA, Silverman ED (1993) A clinical overview of systemic lupus erythematosus in childhood. Pediatr Rev 14:194–201

    CAS  PubMed  Google Scholar 

  7. Pande I, Sekharan NG, Kailash S, Uppal SS, Singh RR, Kumar A, Malaviya AN (1993) Analysis of clinical and laboratory profile in Indian childhood systemic lupus erythematosus and its comparison with SLE in adults. Lupus 2:83–87

    CAS  PubMed  Google Scholar 

  8. Levy M, Montes de Oca M, Claude-Babron M (1994) Unfavorable outcomes (end-stage renal failure/death) in childhood onset systemic lupus erythematosus. A multicenter study in Paris and its environs. Clin Exp Rheumatol 10:63–68

    Google Scholar 

  9. Font J, Cervera R, Espinosa G, Pallares L, Ramos-Casals M, Jimenez S, Garcia-Carrasco M, Seisdedos L, Ingelmo M (1998) Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults. Ann Rheum Dis 57:456–459

    CAS  PubMed  Google Scholar 

  10. Siamopoulou-Mavridou A, Mavridis AK, Dimou G, Drosos AA (1991) Clinical and serological spectrum of systemic lupus erythematosus in Greek children. Clin Rheumatol 10:264–268

    CAS  PubMed  Google Scholar 

  11. Takei S, Maeno N, Shigemori M, Imanaka H, Mori H, Nerome Y, Kanekura S, Takezaki T, Hokonohara M, Miyata K, Fujikawa S (1997) Clinical features of Japanese children and adolescents with systemic lupus erythematosus: results of 1980–1994 survey. Acta Paediatr Jpn 39:250–256

    CAS  PubMed  Google Scholar 

  12. Chandrasekaran AN, Rajendran CP, Ramakrishnan S, Madhavan R, Parthiban M (1994) Childhood systemic lupus erythematosus in south India. Indian J Pediatr 61:223–229

    CAS  PubMed  Google Scholar 

  13. Yalaoui S, Gorgi Y, Meddeb S, Makin S, Lakhoua R, Debbabi A, Ayed K, Ben Maiz H, Hamza M (1993) Lupus in children in Tunisia. Rev Med Interne 14:765–771

    CAS  PubMed  Google Scholar 

  14. Uthman IW, Muffarij AA, Mudawar WA, Nasr FW, Masri AF (2001) Lupus nephritis in Lebanon. Lupus 10:378–381

    CAS  PubMed  Google Scholar 

  15. Al Attia HM, Al Ahmed YH, Chandani AV (1998) Serological markers in Arabs with lupus nephritis. Lupus 7:198–201

    PubMed  Google Scholar 

  16. Brik R, Padeh S, Mukamel M, Navon P, Uziel Y, Kornmehl P, Taub D, Barash Y (1995) Systemic lupus erythematosus in children in Israel. Harefuah 129:233–235, 296, 295

    CAS  PubMed  Google Scholar 

  17. El-Garf A, Salah S (1990) Juvenile systemic lupus erythematosus among Egyptian children. J Rheumatol 17:1168–1170

    CAS  PubMed  Google Scholar 

  18. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277

    CAS  PubMed  Google Scholar 

  19. Update on the 1987 Task Force report on high blood pressure in children and adolescents: a working group report from the national high blood pressure education program (1996). Pediatrics 98:649–658

    PubMed  Google Scholar 

  20. Clark G, Barratt TM (1999) Steroid-responsive nephritic syndrome. In: Barratt TM, Avner ED, Harman WE (eds) Pediatric nephrology. Lippincott Williams and Wilkins, Baltimore, pp 731–747

  21. Churg J, Sobin LH (1981) Renal disease: classification and atlas of glomerular diseases. Igaku-Shoin, Tokyo

    Google Scholar 

  22. Austin HA, Muenz LR, Joyce KM, Antonovych TA, Kullick ME, Klippel JH, Decker JL, Balow JE (1983) Prognostic factors in lupus nephritis. AM J Med 75:382–391

    PubMed  Google Scholar 

  23. Austin HA, Muenz LR, Joyce KM, Antonovych TA, Balow JE (1984) Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome. Kidney Int 25:689–695

    PubMed  Google Scholar 

  24. Bahabri S, Al Sabban E, Al Rashed A, Al-Moyouf S, Al Mazyed A, Abdulrazik A, Al-Dalaan A (1997) Juvenile systemic lupus erythematosus in 60 Saudi children. Ann Saudi Med 17:612–615

    Google Scholar 

  25. Iqbal S, Sher MR, Good RA, Cawkwell GD (1999) Diversity in presenting manifestations of systemic lupus erythematosus in children. J Pediatr 135:500–505

    CAS  PubMed  Google Scholar 

  26. Buoncompagni A, Barbano GC, Pistoia V, Fasce L, Micalizzi C, Gusmano R, Cordone G, Cottafava F, Mori PG, Franchini E (1991) Childhood systemic lupus erythematosus: a review of 30 cases. Rheumatology 9:425–430

    CAS  Google Scholar 

  27. Tucker LB, Menon S, Schaller JC, Isenberg DA (1995) Adult- and childhood-onset systemic lupus erythematosus: a comparison of onset, clinical features, serology, and outcome. Br J Rheum 34:866–872

    CAS  Google Scholar 

  28. Bogdanovic R, Nikolic V, Pasic S, Dimitrijevic J, Markovic JL, Marinkovic JE, Ognjanovic M, Minic A, Stajic N (2004) Lupus nephritis in childhood: a review of 53 patients followed at a single center. Pediatr Nephrol 19:36–44

    Article  PubMed  Google Scholar 

  29. Cameron JS (1994) Lupus nephritis in childhood and adolescence. Pediatr Nephrol 8:230–249

    Article  CAS  PubMed  Google Scholar 

  30. Habib GS, Saliba WR (2002) Systemic lupus erythematosus among Arabs. Isr Med Assoc J 4:690–693

    PubMed  Google Scholar 

  31. Alsaeid K, Kamal H, Haider MZ, Al-Enezi HM, Malaviya AN (2004) Systemic lupus erythematosus in Kuwaiti children: organ s involvement and serological findings. Lupus 13:613–617

    Article  CAS  PubMed  Google Scholar 

  32. Niaudet P (2000) Treatment of lupus nephritis in children. Pediatr Nephrol 14:158–166

    CAS  PubMed  Google Scholar 

  33. Klein-Gitelman M, Reiff A, Silverman ED (2002) Systemic lupus erythematosus in childhood. Rheum Dis Clin N Am 28:561–577

    Article  Google Scholar 

  34. Emre S, Bilge I, Sirin A, Kirikaslan I, Nayir A, Oktem F, Uysal V (2001) Lupus nephritis in children: prognostic significance of clinicopathological findings. Nephron 87:118–126

    Article  CAS  PubMed  Google Scholar 

  35. Bogdanovic’ R, Mikuska M, Cvoric A, Nikolic V, Sindjic M, Ognjanovic M, Abinun M (1994) Lupus nephritis in children and adolescents (clinical and morphological correlation). Srp Arh Celok Lek 122:26–30

    Google Scholar 

  36. Zappitelli M, Duffy C, Bernard C, Scuccimarri R, Duffy KW, Kagan R, Gupta IR (2004) Clinicopathological study of the WHO classification in childhood lupus nephritis. Pediatr Nephrol 19:503–510

    Article  PubMed  Google Scholar 

  37. 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 7:924–929

    CAS  PubMed  Google Scholar 

  38. Zwolinska D, Kilis PK, Wikiera I, Medynska A (2000) Lupus nephritis in children. Pol Merkuriusz Lek 8:454–456

    CAS  PubMed  Google Scholar 

  39. Yang LY, Chen WP, Lin CY (1994) Lupus nephritis in children: a review of 167 patients. Pediatrics 94:335–340

    CAS  PubMed  Google Scholar 

  40. Al Salloum AA (2003) Cyclophosphamide therapy for lupus nephritis: poor renal survival in Arab children. Pediatr Nephrol 18:357–361

    PubMed  Google Scholar 

  41. Lehman TJA, Onel K (2000) Intermittent intravenous cyclophosphamide arrests progression of the renal chronicity index in childhood systemic lupus erythematosus. J Pediatr 136:243–247

    CAS  PubMed  Google Scholar 

  42. Buratti S, Szer IS, Spencer CH, Bartosh S, Reiff A (2001) Mycophenolate mofetil treatment of severe renal disease in pediatric onset systemic lupus erythematosus. J Rheumatol 28:2103–2108

    CAS  PubMed  Google Scholar 

  43. Huang JL, Lin CJ, Hung IJ, Luo SF (1994) The morbidity and mortality associated with childhood onset systemic lupus erythematosus. Changgeng Yi Xue Za Zhi 17:113–120

    CAS  PubMed  Google Scholar 

  44. Singh S, Devidayal, Kumar L, Joshi K (2002) Mortality patterns in childhood lupus: 10 years’ experience in a developing country. Clin Rheumatol 21:462–465

    Article  CAS  PubMed  Google Scholar 

  45. Dooley MA, Hogan S, Jennette C, Falk R (1997) Cyclophosphamide therapy for lupus nephritis: poor renal survival in black Americans. Kidney Int 51:1188–1195

    CAS  PubMed  Google Scholar 

  46. Kopkinson ND, Jenkinson C, Muir KR, Doherty M, Powell RJ (2000) Racial group, socioeconomic status, and the development of persistent proteinuria in systemic lupus erythematosus. Ann Rheum Dis 59:116–119

    PubMed  Google Scholar 

  47. Austin HA, Balow J (1999) Natural history and treatment of lupus nephritis. Semin Nephrol 19:2–11

    CAS  PubMed  Google Scholar 

  48. Hagelberg S, Lee Y, Bargman J, Mah G, Schneider R, Laskin C, Eddy A, Gladman D, Urowitz M, Hebert D, Silverman E (2002) Longterm followup of childhood lupus nephritis. J Rheumatol 29:2635–2642

    PubMed  Google Scholar 

  49. Bono L, Cameron JS, Hicks JA (1999) The very long-term prognosis and complications of lupus nephritis and its treatment. Q J Med 92:211–218

    CAS  Google Scholar 

  50. Cameron JS (1999) Lupus nephritis. J Am Soc Nephrol 10:413–424

    CAS  PubMed  Google Scholar 

  51. Austin HA, Boumpas DT, Vaughan EM, Balow JE (1994) Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data. Kidney Int 45:544–550

    PubMed  Google Scholar 

  52. Donadio JV, Hart GM, Bergstralh EJ, Holley KE (1995) Prognostic determinants in lupus nephritis: a long-term clinicopathologic study. Lupus 4:109–115

    PubMed  Google Scholar 

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Acknowledgements

I would like to thank Prof. Fatma Alhusseni, Professor of Pathology, for doing the histopathological diagnosis. I would also like to thank Dr. Atef Almougy for his help in retrieving data from patients’ files. Many thanks to Dr. Basem El-Diek for helping with the statistical analysis.

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Correspondence to Ashraf Bakr.

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Bakr, A. Epidemiology treatment and outcome of childhood systemic lupus erythematosus in Egypt. Pediatr Nephrol 20, 1081–1086 (2005). https://doi.org/10.1007/s00467-005-1900-2

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