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Kidney Week

Abstract: TH-PO657

Induction Therapy and Kidney Outcomes in Pediatric Lupus Nephritis: A Prospective Study from the Pediatric Nephrology Research Consortium

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Phillips, Melonie Anne, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Kallash, Mahmoud, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Tang, Hancong, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Rust, Steve, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Wenderfer, Scott E., Texas Children's Hospital, Houston, Texas, United States
  • Vasylyeva, Tetyana L., Texas Tech University Health Sciences Center, Lubbock, Texas, United States
  • Lane, Jerome C., Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
Background

Pediatric lupus nephritis (pLN) occurs in 30-50% of children with SLE and is usually more severe compared to adults. Despite that, treatment protocols and outcome data have been limited, mostly constructed using adult studies. In this study, we aim to evaluate the management and outcome of pLN in a large prospective observational multi-center study.

Methods

Patients <21 years of age with new diagnosis of pLN were enrolled at 8 sites across the United States between 2011 and 2019. Induction therapy was determined by the treating practioner. We evaluated 6, 12, and 24-month remission rates, using the American College of Rheumatology guidelines, and kidney outcomes based on induction therapy with Mycophenolate Mofetil (MMF) or Cyclophosphamide (CYC).

Results

Study included 107 patients. The median age at diagnosis was 14 years (range 7-19 years), and 81% of patients were female. Induction treatment varied significantly across institutions, but most patients received MMF (38%) or CYC (21%). 48 patients with proliferative pLN (III, IV, and V + III or IV) received either MMF or CYC. Combined complete and partial remission rates at 6, 12, and 24 months in proliferative pLN with MMF vs CYC induction therapies are listed in table 1. There were no differences in eGFR, proteinuria, or infection rate between CYC vs MMF at 6, 12, or 24 months. Propensity analysis showed that patients with pLN class IV and lower albumin were more likely to receive CYC.

Conclusion

Remission rates and kidney outcomes were similar between children who received induction MMF vs CYC in proliferative pLN. There were significant variations in induction therapy used to manage pLN, which highlights the need for pediatric-focused LN studies to develop standardized treatment regimens and provide equitable care to patients.