RT Journal Article SR Electronic T1 Longterm followup of childhood lupus nephritis. JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP 2635 OP 2642 VO 29 IS 12 A1 Stefan Hagelberg A1 Yuna Lee A1 Joanne Bargman A1 Gordon Mah A1 Rayfel Schneider A1 Carl Laskin A1 Allison Eddy A1 Dafna Gladman A1 Murray Urowitz A1 Diane Hebert A1 Earl Silverman YR 2002 UL http://www.jrheum.org/content/29/12/2635.abstract AB OBJECTIVE: To determine the longterm outcome in children with onset of lupus nephritis before 18 years of age. METHODS: Sixty-seven patients with onset of lupus nephritis prior to age 18 were identified. The mean followup time was 11 years (range 5-19). The mean age at diagnosis was 13.2 years (range 4-17). The male:female ratio was 1:3.8. Renal biopsies were classified using the WHO classification. Fifteen patients had Class II, 8 patients Class III, 32 patients Class IV, and 11 patients Class V and one patient refused biopsy. The cohort consists of the 66 patients who had a renal biopsy. Five patients received cyclophosphamide (CYC) and 17 received azathioprine (AZA) as part of the initial treatment of Class IV nephritis. Eight additional patients received CYC because of a flare of disease while receiving AZA, and 8 other patients received AZA because of a flare of disease while taking prednisone therapy. RESULTS: Four patients died; 6 developed endstage renal disease (ESRD); all but one of the patients who died and/or had ESRD had WHO Class IV [diffuse proliferative glomerulonephritis (DPGN)]; only 2 Caucasians developed ESRD, although 16 out of 36 Caucasians had DPGN; serum creatinine at followup was normal in 84% of the survivors; presently 70% of the patients take less than 7.5 mg prednisone/day and 62% do not take cytotoxic drugs. No patient is currently treated with CYC. All 8 patients with Class III nephritis were taking medication at last followup. CONCLUSION: The longterm outcome in this group of children with lupus nephritis, in whom AZA was the most commonly used immunosuppressive agent, was excellent, with 94% patient survival at a mean followup of 11 years. Our results suggest that non-Caucasian patients with pediatric onset lupus nephritis may be at increased risk for renal failure compared to Caucasians.