A Clinico-pathologic Study of Childhood Lupus Nephritis

Rho, Youn Sook; Cha, Sung Hoo; Cho, Byoung Soo

Abstract

PURPOSE: Systemic lupus erythematosus(SLE) is a disease of immunologic origin, affecting multiple organs including joints, skin, kidneys, nervous system, heart and blood, with rare involvement of gut and liver. The incidence of renal disease in children with SLE was approximately 70 percent and tended to be more severe than in adults. Accordingly we have retrospectively studied on the prognostic indicators.
METHODS
We investigated clinical manifestations, laboratory findings and renal biopsy findings of 14 cases of childhood lupus nephritis.
RESULTS
A review of the clinical and pathological findings revealed as follows : male to female ratio was 1 : 6, immunologic laboratory findings showed, positive rates of anti-ds DNA antibody which was 57%, FANA 85%. The incidence of decreased C3 and C4 was 57%. The most common clinical features were fever(92%) and malar rash(21%). Renal biopsies were performed with the following results. There were 3 cases of mesangial proliferative glomerulonephritis, 1 case of focal and segmental proliferative glomerulonephritis, 9 cases of diffuse proliferative glomerulonephritis, and 1 of membranous glomerulonephritis. During the follow-up period, 3 patients with diffuse proliferative glomerulonephritis expired due to renal failure and pulmonary edema.
CONCLUSION
When lupus nephritis is suspected, renal biopsy, tests for antinuclear antibody (ANA) and anti-ds-DNA, and complement profile should be performed. Early diagnosis and proper treatment can prevent rapid deterioration of renal function and improve long-term survival. Renal biopsy in lupus nephritis is of considerable value to both choice of therapy and predicting prognosis.