Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus

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dc.contributor.authorSakamoto, Ana P.
dc.contributor.authorSilva, Clovis A.
dc.contributor.authorIslabão, Aline G.
dc.contributor.authorNovak, Glaucia V.
dc.contributor.authorMolinari, Beatriz
dc.contributor.authorNogueira, Paulo K.
dc.contributor.authorPereira, Rosa M. R.
dc.contributor.authorSaad-Magalhães, Claudia [UNESP]
dc.contributor.authorClemente, Gleice
dc.contributor.authorPiotto, Daniela P.
dc.contributor.authorAikawa, Nadia E.
dc.contributor.authorPitta, Ana C.
dc.contributor.authorTrindade, Vitor C.
dc.contributor.authorAppenzeller, Simone
dc.contributor.authorCarvalho, Luciana M.
dc.contributor.authorRabelo-Junior, Carlos N.
dc.contributor.authorFonseca, Adriana R.
dc.contributor.authorSztajnbok, Flavio R.
dc.contributor.authorSantos, Maria C.
dc.contributor.authorBica, Blanca E.
dc.contributor.authorSena, Evaldo G.
dc.contributor.authorMoraes, Ana J.
dc.contributor.authorFraga, Melissa M.
dc.contributor.authorRobazzi, Teresa C.
dc.contributor.authorSpelling, Paulo F.
dc.contributor.authorScheibel, Iloite M.
dc.contributor.authorCavalcanti, Andre S.
dc.contributor.authorMatos, Erica N.
dc.contributor.authorGuimarães, Luciano J.
dc.contributor.authorSantos, Flavia P.
dc.contributor.authorMota, Licia M. H.
dc.contributor.authorBonfá, Eloisa
dc.contributor.authorTerreri, Maria T.
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.contributor.institutionHospital da Crianca de Brasilia Jose Alencar
dc.contributor.institutionUniversidade Estadual Paulista (UNESP)
dc.contributor.institutionUniversidade Estadual de Campinas (UNICAMP)
dc.contributor.institutionHospital Geral de Fortaleza
dc.contributor.institutionUniversidade Federal do Rio de Janeiro (UFRJ)
dc.contributor.institutionPedro Ernesto University Hospital
dc.contributor.institutionIrmandade da Santa Casa de Misericordia de Sao Paulo
dc.contributor.institutionUniversidade Federal da Paraiba
dc.contributor.institutionFederal University of Para
dc.contributor.institutionHospital Infantil Darcy Vargas
dc.contributor.institutionUniversidade Federal da Bahia (UFBA)
dc.contributor.institutionHospital Evangelico de Curitiba
dc.contributor.institutionHospital Crianca Conceicao
dc.contributor.institutionUniversidade Federal de Pernambuco (UFPE)
dc.contributor.institutionFederal University of Mato Grosso do Sul
dc.contributor.institutionUniversity of Brasilia
dc.contributor.institutionUniversidade Federal de Minas Gerais (UFMG)
dc.date.accessioned2023-07-29T13:29:18Z
dc.date.available2023-07-29T13:29:18Z
dc.date.issued2023-06-01
dc.description.abstractBackground: Lupus nephritis (LN) is a frequent manifestation of childhood-onset systemic lupus erythematosus (cSLE) with a potential risk for kidney failure and poor outcomes. This study aimed to evaluate stages III, IV, and V of chronic kidney disease (CKD) and investigate risk factors for CKD in cSLE patients. Methods: We performed a nationwide observational cohort study in 27 pediatric rheumatology centers, including medical charts of 1528 cSLE patients. Data were collected at cSLE diagnosis, during follow-up, and at last visit or death, between September 2016 and May 2019. Results: Of 1077 patients with LN, 59 (5.4%) presented with CKD, 36/59 (61%) needed dialysis, and 7/59 (11.8%) were submitted for kidney transplantation. After Bonferroni’s correction for multiple comparisons (p < 0.0013), determinants associated with CKD were higher age at last visit, urinary biomarker abnormalities, neuropsychiatric involvement, higher scores of disease activity at last visit and damage index, and more frequent use of methylprednisolone, cyclosporine, cyclophosphamide, and rituximab. In the regression model analysis, arterial hypertension (HR = 15.42, 95% CI = 6.12–38.83, p ≤ 0.001) and biopsy-proven proliferative nephritis (HR = 2.83, 95%CI = 1.70–4.72, p ≤ 0.001) increased the risk of CKD, while children using antimalarials had 71.0% lower CKD risk ((1.00–0.29) × 100%) than children not using them. The Kaplan–Meier comparison showed lower survival in cSLE patients with biopsy-proven proliferative nephritis (p = 0.02) and CKD (p ≤ 0.001). Conclusions: A small number of patients manifested CKD; however, frequencies of dialysis and kidney transplantation were relevant. This study reveals that patients with cSLE with hypertension, proliferative nephritis, and absence of use of antimalarials exhibited higher hazard rates of progression to CKD. Graphical Abstract: [Figure not available: see fulltext.]en
dc.description.affiliationPediatric Rheumatology Unit Universidade Federal de Sao Paulo, SP
dc.description.affiliationPediatric Rheumatology Unit Children’s Institute Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de Sao Paulo
dc.description.affiliationPediatric Rheumatology Unit Hospital da Crianca de Brasilia Jose Alencar, DF
dc.description.affiliationPediatric Nephrology Unit Universidade Federal de Sao Paulo, SP
dc.description.affiliationDivision of Rheumatology Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de Sao Paulo, SP
dc.description.affiliationPediatric Rheumatology Division Sao Paulo State University (UNESP)–Faculdade de Medicina de Botucatu, SP
dc.description.affiliationDepartment of Orthopedics Rheumatology and Traumatology–School of Medical Science–University of Campinas (UNICAMP), SP
dc.description.affiliationPediatric Rheumatology Unit Ribeirao Preto Medical School–University of Sao Paulo, SP
dc.description.affiliationPediatric Rheumatology Unit Hospital Geral de Fortaleza, CE
dc.description.affiliationPediatric Rheumatology Unit Rio de Janeiro Federal University (IPPMG-UFRJ), RJ
dc.description.affiliationPediatric Rheumatology Unit Pedro Ernesto University Hospital, RJ
dc.description.affiliationPediatric Rheumatology Unit Irmandade da Santa Casa de Misericordia de Sao Paulo, SP
dc.description.affiliationRheumatology Division Universidade Federal do Rio de Janeiro Hospital Universitario Clementino Fraga Filho, RJ
dc.description.affiliationPediatric Rheumatology Unit Lauro Wanderley University Hospital Universidade Federal da Paraiba, PB
dc.description.affiliationPediatric Rheumatology Unit Federal University of Para, PA
dc.description.affiliationPediatric Rheumatology Unit Hospital Infantil Darcy Vargas, SP
dc.description.affiliationPediatric Rheumatology Unit Federal University of Bahia, BA
dc.description.affiliationPediatric Rheumatology Unit Hospital Evangelico de Curitiba, PR
dc.description.affiliationPediatric Rheumatology Unit Hospital Crianca Conceicao, RS
dc.description.affiliationPediatric Rheumatology Unit Federal University of Pernambuco, PE
dc.description.affiliationPediatric Rheumatology Unit Federal University of Mato Grosso do Sul, MS
dc.description.affiliationPediatric Rheumatology Unit University of Brasilia, DF
dc.description.affiliationPediatric Rheumatology Unit Federal University of Minas Gerais, MG
dc.description.affiliationRheumatology Unit University of Brasilia
dc.description.affiliationUnespPediatric Rheumatology Division Sao Paulo State University (UNESP)–Faculdade de Medicina de Botucatu, SP
dc.description.sponsorshipCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorshipFundação de Apoio à Pesquisa do Rio Grande do Norte
dc.description.sponsorshipIdFundação de Apoio à Pesquisa do Rio Grande do Norte: 2015/03756-4
dc.format.extent1843-1854
dc.identifierhttp://dx.doi.org/10.1007/s00467-022-05811-y
dc.identifier.citationPediatric Nephrology, v. 38, n. 6, p. 1843-1854, 2023.
dc.identifier.doi10.1007/s00467-022-05811-y
dc.identifier.issn1432-198X
dc.identifier.issn0931-041X
dc.identifier.scopus2-s2.0-85142222343
dc.identifier.urihttp://hdl.handle.net/11449/247913
dc.language.isoeng
dc.relation.ispartofPediatric Nephrology
dc.sourceScopus
dc.subjectAdolescent
dc.subjectChildhood
dc.subjectChildhood-onset systemic lupus erythematosus
dc.subjectChronic kidney disease
dc.subjectLupus nephritis
dc.subjectSystemic lupus erythematosus
dc.titleChronic kidney disease in patients with childhood-onset systemic lupus erythematosusen
dc.typeArtigo
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