Lupus nephritis in children

Objective: To determine the clinicopathological pattern of lupus nephritis in paediatric nephrology patients. Design: Case series study. Place and Duration of Study: The department of paediatric nephrology at the Children's Hospital and Institute of Child Health, Lahore, Pakistan, over a period of five years from January 2001 to December 2005. Patients and Methods: Twenty six patients upto the age 16 years of either gender, with a mean age of 12.4 +/- 1.90 years having primary SLE with renal involvement in the form of oedema, hypertension, haematuria and proteinuria were included. Twenty one were females. Percutaneous renal biopsy was performed. Histological lesion was classified according to WHO classification. Patients were treated with immunosuppressive therapy and their clinical course was followed for at least one year. The mean duration of follow up was 1.77 years. Results: Renal involvement was seen in 92.30% within 2 years of the onset of primary disease. Diffuse proliferative glomerulonephritis was the commonest histological lesion (n=14) followed by membranous nephropathy (n=6). The commonest clinical manifestation was oedema (80.76%) followed by hypertension (46.15%). Proteinuria was present in 100% of cases, haematuria in 38.46% and azotemia in 19.33% of patients. Nephrotic range proteinuria was more common in class III and IV, while azotemia was observed only in class IV The disease wets well controlled in 73.07%, relapse was seen in 3.8% of patients, 15.38% died of infections and uremic encephalopathy while 7.69% were lost to follow-up. Conclusion: Diffuse proliferative glomerulonephritis is the commonest histological lesion in our set-up. Renal involvement is mostly seen within first two years of the primary disease which can be controlled satisfactorily with immunosuppressive therapy.