Lupus nephritis in children

Lupus nephritis (LN) is a common companion of systemic lupus erythematosus (SLE) in children, presenting through the course of the disease with diverse symptoms ranging from silent LN to nephrotic syndrome and acute nephritic syndrome. Therefore, children with SLE should be regularly screened for LN, while in children with established LN, disease should be regularly monitored, as explained in the following slides.

Lupus Nephritis in Children :

• Renal involvement occurs in 50 to 75% of all children with SLE, and more than 90% of those who will develop renal disease will do so within the first 2 years after diagnosis;

• Renal involvement is characterised by a relapsing and remitting course, requiring close surveillance and prompt treatment to prevent renal damage;

• The extent of kidney involvement often dictates treatment choices in children with lupus!

Different presentation of lupus nephritis in children

• Silent “Lupus nephritis” : Normal urin­alysis , normal renal function, no proteinuria

• Nephrotic syndrome : Proteinuria > 40 mg/m2/h, hypoalbuminemia < 30g/L, oedema, hyperlipidaemia

• Acute Nephritic Syndrome : Haematuria, proteinuria, oliguria, oedema, hypertension, decrease of GFR

Screening for lupus nephritis onset or flares

Patients with SLE should be screened periodically even during periods of remission or low disease activity

REGULAR SCREENING : Volume status; Blood pressure; Urinalysis; Serum parameters (creatinine);

ONSET OR INCREASED ACTIVITY OF LUPUS NEPHRITIS : Elevation of serum creatinine; Dysmorphic erythrocytes; Cellular casts; New onset proteinuria

Monitoring of lupus nephritis

Renal histology is the gold standard for diagnosing and predicating renal prognosis in LN, but only provides a snapshot of a discrete area of the kidney and is rarely repeated for monitoring purposes due to its invasive nature.

Along with traditional biomarkers, new biomarkers to identify active lupus nephritis are being tested and validated in various cohorts of children with lupus nephritis.

By Lovro Lamot (Croatia).

Based upon work from COST Action CA21168, Project CliPS - Working Group"Lupus nephritis management in children". Supported by COST (European Cooperation in Science and Technology). www.cost.eu

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