Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
Department of Pediatrics, Kakogawa Central City Hospital, Hyogo, Japan.
Mod Rheumatol. 2019 Nov;29(6):970-976. doi: 10.1080/14397595.2018.1532861. Epub 2018 Dec 18.
Acute kidney injury (AKI) at onset of adult systemic lupus erythematosus (SLE) is a risk factor for end stage kidney disease (ESKD). However, data on childhood-onset lupus nephritis (LN) with AKI are scarce. We retrospectively reviewed the complete files of pediatric SLE patients from 1995 to 2010. All patients underwent kidney biopsy promptly after diagnosis. Thirty-six patients (10 males and 26 females) were enrolled. Mean age at diagnosis and observation period were 11.6 ± 2.4 and 8.1 ± 4.4 years, respectively. Seven patients had AKI at onset of SLE. Compared with those without AKI, patients with AKI had significantly higher proportions of pathologically proliferative LN. Only one patient with AKI progressed to ESKD without complete recovery of renal function. Overall and renal survival rates were 100and 97.2%, respectively. There was no significant difference in estimated glomerular filtration rate at the final visit (85ml/min/1.73 m in the AKI group vs. 103.2 ml/min/1.73 m in the non-AKI group; = .11). Our study demonstrated favorable renal outcomes in childhood-onset LN with AKI in the near to midterm period. Inducing complete remission may be important for preserving renal function.
成人系统性红斑狼疮（SLE）发病时的急性肾损伤（AKI）是终末期肾病（ESKD）的危险因素。然而，关于伴有 AKI 的儿童发病狼疮肾炎（LN）的数据很少。我们回顾性地分析了 1995 年至 2010 年期间的儿科 SLE 患者的完整病历。所有患者在诊断后均立即进行了肾活检。共纳入 36 例患者（男 10 例，女 26 例）。诊断时的平均年龄和观察期分别为 11.6±2.4 岁和 8.1±4.4 年。7 例患者在 SLE 发病时出现 AKI。与无 AKI 患者相比，AKI 患者的病理增殖性 LN 比例显著更高。仅有 1 例 AKI 患者进展为 ESKD，肾功能未完全恢复。总体和肾脏存活率分别为 100%和 97.2%。在最后一次就诊时，估计肾小球滤过率无显著差异（AKI 组为 85ml/min/1.73m，非 AKI 组为 103.2ml/min/1.73m；=0.11）。我们的研究表明，在近中期，伴有 AKI 的儿童发病 LN 具有良好的肾脏预后。诱导完全缓解可能对保护肾功能很重要。
