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Chuah AMJ, Chan EYH, Tong PC, Ma ALT. Incidental finding of acquired cystic kidney disease associated renal cell carcinoma in an adolescent with kidney failure. Pediatr Nephrol 2024:10.1007/s00467-024-06364-y. [PMID: 38597973 DOI: 10.1007/s00467-024-06364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024]
Abstract
Acquired cystic kidney disease (ACKD) can occur in patients with chronic kidney disease and kidney failure, and its incidence increases with the duration of dialysis. In adults, ACKD is less common in the pre-dialysis group (~ 7%), but its incidence can be as high as 80% for those who are on dialysis for more than ten years. There is, however, very little information about the prevalence of ACKD in children. We report a case of malignant transformation of ACKD following a kidney transplant, highlighting the importance of surveillance of the native kidneys in paediatric patients who have been in long-term kidney replacement therapy.
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Affiliation(s)
- Alice Ming-Jie Chuah
- Paediatric Nephrology Unit, Woman and Children's Hospital, Kuala Lumpur, Malaysia
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR
| | - Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR.
- Department of Paediatrics, Chinese University of Hong Kong, Shatin, Hong Kong SAR.
| | - Pak-Chiu Tong
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR
| | - Alison Lap-Tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR
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2
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Chan EYH, Yap DYH, Wong WHS, Wong SW, Lin KYK, Hui FYW, Li JYM, Lam SSY, Wong JKY, Lai FFY, Ho TW, Tong PC, Lai WM, Chan TM, Ma ALT. Renal relapse in children and adolescents with childhood-onset lupus nephritis: a 20-year study. Rheumatology (Oxford) 2024; 63:953-961. [PMID: 37632777 DOI: 10.1093/rheumatology/kead447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVES There is little data on renal relapse in childhood-onset LN (cLN). We investigate the incidence, predictive factors and outcomes related to renal relapse. METHODS We conducted a retrospective cohort study of all cLN diagnosed at ≤18 years between 2001-2021 to investigate the incidence and outcomes related to renal relapse. RESULTS Ninety-five Chinese cLN patients (91% proliferative LN) were included. Induction immunosuppression was prednisolone and CYC [n = 36 (38%)] or MMF [n = 33 (35%)]. Maintenance immunosuppression was prednisolone and MMF [n = 53 (54%)] or AZA [n = 29 (31%)]. The rates of complete remission/partial remission (CR/PR) at 12 months were 78.9%/7.4%. Seventy renal relapses occurred in 39 patients over a follow-up of 10.2 years (s.d. 5.9) (0.07 episode/patient-year). Relapse-free survival was 94.7, 86.0, 80.1, 71.2, 68.3, 50.3 and 44.5% at 1, 2, 3, 4, 5, 10 and 20 years, respectively. Multivariate analysis showed that LN diagnosis <13.1 years [adjusted hazard ratio (HRadj) 2.59 995% CI 1.27, 5.29), P = 0.01], AZA maintenance [HRadj 2.20 (95% CI 1.01, 4.79), P = 0.05], PR [HRadj 3.9 (95% CI 1.03, 9.19), P = 0.01] and non-remission [HRadj 3.08 (95% CI 1.35, 11.3), P = 0.04] at 12 months were predictive of renal relapse. Renal relapse was significantly associated with advanced chronic kidney disease (stages 3-5) and end-stage kidney disease (17.9% vs 1.8%, P < 0.01). Furthermore, patients with renal relapse showed an increased incidence of infections (30.8% vs 10.7%, P = 0.02), osteopenia (38.5% vs 17.9%, P = 0.04) and hypertension (30.8% vs 7.1%, P < 0.01). CONCLUSION Renal relapse is common among cLN, especially among young patients, and is associated with an increased incidence of morbidity and mortality. Attaining CR and the use of MMF appear to decrease the incidence of renal relapse.
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Affiliation(s)
- Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong
| | - Desmond Yat-Hin Yap
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong School of Clinical Medicine, Hong Kong
| | | | - Sze-Wa Wong
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
| | - Kyle Ying-Kit Lin
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
| | - Felix Yan-Wai Hui
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
| | | | | | | | | | - Tsz-Wai Ho
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
| | - Pak-Chiu Tong
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
| | - Wai-Ming Lai
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
| | - Tak Mao Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong School of Clinical Medicine, Hong Kong
| | - Alison Lap-Tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong
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Chan EYH, Lai FFY, Ma ALT, Chan TM. Managing Lupus Nephritis in Children and Adolescents. Paediatr Drugs 2024; 26:145-161. [PMID: 38117412 DOI: 10.1007/s40272-023-00609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
Lupus nephritis is an important manifestation of systemic lupus erythematosus, which leads to chronic kidney disease, kidney failure, and can result in mortality. About 35%-60% of children with systemic lupus erythematosus develop kidney involvement. Over the past few decades, the outcome of patients with lupus nephritis has improved significantly with advances in immunosuppressive therapies and clinical management. Nonetheless, there is a paucity of high-level evidence to guide the management of childhood-onset lupus nephritis, because of the relatively small number of patients at each centre and also because children and adolescents are often excluded from clinical trials. Children and adults differ in more ways than just size, and there are remarkable differences between childhood- and adult-onset lupus nephritis in terms of disease severity, treatment efficacy, tolerance to medications and most importantly, psychosocial perspective. In this article, we review the 'art and science' of managing childhood-onset lupus nephritis, which has evolved in recent years, and highlight special considerations in this specific patient population.
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Affiliation(s)
- Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong.
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
| | - Fiona Fung-Yee Lai
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Alison Lap-Tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Tak Mao Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong.
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, School of Clinical Medicine, Pok Fu Lam, Hong Kong.
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4
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Lai FFY, Chan EYH, Tullus K, Ma ALT. Therapeutic drug monitoring in childhood idiopathic nephrotic syndrome: a state of the art review. Pediatr Nephrol 2024; 39:85-103. [PMID: 37147510 DOI: 10.1007/s00467-023-05974-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 05/07/2023]
Abstract
Immunosuppressants are commonly used as steroid-sparing agents in childhood idiopathic nephrotic syndrome (NS) to induce and sustain remissions. These drugs have narrow therapeutic indices with high inter- and intra-patient variability. Therapeutic drug monitoring (TDM) would therefore be essential to guide the prescription. Multiple factors in NS contribute to additional variability in drug concentrations, especially during relapses. In this article, we review the currently available evidence of TDM in NS and suggest a practical approach for clinicians' reference.
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Affiliation(s)
- Fiona Fung-Yee Lai
- Department of Pharmacy, Hong Kong Children's Hospital, Kowloon City, Hong Kong
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong
| | - Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong.
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Alison Lap-Tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong
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5
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Chan EYH, Wong SW, Lai FFY, Ho TW, Tong PC, Lai WM, Ma ALT, Yap DYH. Long-term outcomes with rituximab as add-on therapy in severe childhood-onset lupus nephritis. Pediatr Nephrol 2023; 38:4001-4011. [PMID: 37358717 DOI: 10.1007/s00467-023-06025-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Long-term data pertaining to rituximab as add-on therapy in childhood-onset lupus nephritis (cLN) is scarce. METHODS A retrospective cohort study was conducted on all patients with proliferative cLN, diagnosed ≤ 18 years and between 2005 and 2021, who received rituximab for LN episodes that were life/organ threatening and/or treatment resistant to standard immunosuppression. RESULTS Fourteen patients with cLN (female, n = 10) were included, with median follow-up period of 6.9 years. LN episodes (class III, n = 1; class IV, n = 11; class IV + V, n = 2) requiring rituximab occurred at 15.6 years (IQR 12.8-17.3), urine protein:creatinine ratio was 8.2 mg/mg (IQR 3.4-10.1) and eGFR was 28 mL/min/1.73 m2 (IQR 24-69) prior to rituximab treatment. Ten and four patients received rituximab at 1500 mg/m2 and 750 mg/m2, which were given at 46.5 days (IQR 19-69) after commencement of standard therapies. Treatment with rituximab resulted in improvements in proteinuria (ps < 0.001), eGFR (ps < 0.01) and serological parameters, including haemoglobin levels, complement 3 levels and anti-dsDNA antibodies, compared with baseline. Rates of complete/partial remission at 6-, 12- and 24-month post-rituximab were 28.6/42.8%, 64.2/21.4% and 69.2/15.3%. All three patients who required acute kidney replacement therapy became dialysis-free after rituximab. Relapse rate following rituximab was 0.11 episodes/patient-year. There was no lethal complication or severe infusion reaction. Hypogammaglobulinaemia was the most frequent complication (45%) but was mostly asymptomatic. Neutropenia and infections were observed in 20% and 25% of treatments. Upon last follow-up, three (21%) and two (14%) patients developed chronic kidney disease (stage 2, n = 2; stage 4; n = 1) and kidney failure, respectively. CONCLUSION Add-on rituximab is an effective and safe rescue therapy for cLN patients with life-/organ-threatening manifestations or treatment-resistance. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR.
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
| | - Sze-Wa Wong
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR
| | - Fiona Fung-Yee Lai
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR
| | - Tsz-Wai Ho
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR
| | - Pak-Chiu Tong
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR
| | - Wai-Ming Lai
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR
| | - Alison Lap-Tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR.
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
| | - Desmond Yat-Hin Yap
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR.
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong School of Clinical Medicine, Pokfulam, Hong Kong SAR.
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Lam SY, Chan EYH, Cheng FWT, Ma ALT, Ha SY. Acute kidney injury in children with haematological malignancy: a territory-wide study. Pediatr Nephrol 2023; 38:3823-3833. [PMID: 37219640 DOI: 10.1007/s00467-023-06010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND In onco-nephrology, data on acute kidney injury (AKI) among children with haematological malignancies are scarce. METHODS A retrospective cohort study of all patients in Hong Kong diagnosed with haematological malignancies from 2019 to 2021 before 18 years of age, was conducted to investigate the epidemiology, risk factors and clinical outcomes of AKI during the first year of treatment. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. RESULTS We included 130 children with haematological malignancy at median age of 9.4 years (IQR, 3.9-14.1). Of these patients, 55.4% were acute lymphoblastic leukemia (ALL), 26.9% were lymphoma and 17.7% were acute myeloid leukemia (AML). Thirty-five patients (26.9%) developed 41 AKI episodes during the first year of diagnosis, corresponding to 32 episodes per 100-patient-year. A total of 56.1% and 29.2% of the AKI episodes occurred during induction and consolidation chemotherapy respectively. Septic shock (n = 12, 29.2%) was the leading cause of AKI; 21 episodes (51.2%) were stage 3 AKI; 12 episodes (29.3%) were stage 2 AKI; and 6 patients required continuous kidney replacement therapies. Tumor lysis syndrome and impaired baseline kidney function were significantly associated with AKI on multivariate analysis (P = 0.01). History of AKI was associated with chemotherapy postponement (37.1% vs. 16.8%, P = 0.01), worse 12-month patient survival (77.1% vs. 94.7%, log rank P = 0.002) and lower disease remission rate at 12-month (68.6% vs. 88.4%, P = 0.007), compared to patients without AKI. CONCLUSION AKI is a common complication during treatment of haematological malignancies which is associated with worse treatment outcomes. A regular and dedicated surveillance program for at-risk patients should be studied in children with haematological malignancies for prevention and early detection of AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Suet Ying Lam
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong
| | - Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong.
| | - Frankie Wai Tso Cheng
- Haematology and Oncology Centre, Department of Paediatric and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon City, Hong Kong
| | - Alison Lap Tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong
| | - Shau Yin Ha
- Haematology and Oncology Centre, Department of Paediatric and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon City, Hong Kong
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7
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Chan EYH, Yap DYH, Colucci M, Ma ALT, Parekh RS, Tullus K. Use of Rituximab in Childhood Idiopathic Nephrotic Syndrome. Clin J Am Soc Nephrol 2023; 18:533-548. [PMID: 36456193 PMCID: PMC10103321 DOI: 10.2215/cjn.08570722] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022]
Abstract
Rituximab is an established therapy in children with idiopathic nephrotic syndrome to sustain short- to medium-term disease remission and avoid steroid toxicities. Recent trials focus on its use as a first-line agent among those with milder disease severity. Rituximab is used in multidrug refractory nephrotic syndrome and post-transplant disease recurrence, although the evidence is much less substantial. Available data suggest that the treatment response to rituximab depends on various patient factors, dosing regimen, and the concomitant use of maintenance immunosuppression. After repeated treatments, patients are found to have an improving response overall with a longer relapse-free period. The drug effect, however, is not permanent, and 80% of patients eventually relapse and many will require an additional course of rituximab. This underpins the importance of understanding the long-term safety profile on repeated treatments. Although rituximab appears to be generally safe, there are concerns about long-term hypogammaglobulinemia, especially in young children. Reliable immunophenotyping and biomarkers are yet to be discovered to predict treatment success, risk of both rare and severe side effects, e.g. , persistent hypogammaglobulinemia, and guiding of redosing strategy. In this review, we highlight recent advances in the use of rituximab for childhood nephrotic syndrome and how the therapeutic landscape is evolving.
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Affiliation(s)
- Eugene Yu-hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Desmond Yat-hin Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Manuela Colucci
- Renal Diseases Research Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alison Lap-tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon, Hong Kong
- Department of Paediatric and Adolescent Medicine, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Rulan S. Parekh
- Departments of Medicine and Pediatrics, Women's College Hospital, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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8
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Filler G, Sharma AP, Díaz González de Ferris ME. The ongoing need to improve long-term patient survival of pediatric solid organ recipients. Pediatr Transplant 2023; 27:e14465. [PMID: 36591816 DOI: 10.1111/petr.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Guido Filler
- Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada.,Department of Pathology & Laboratory Medicine, University of Western Ontario, London, Ontario, Canada.,Lilibeth Caberto Kidney Clinical Research Unit, London, Ontario, Canada
| | - Ajay Parkesh Sharma
- Department of Paediatrics, University of Western Ontario, London, Ontario, Canada
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Chan EYH, Liu MS, Or PC, Ma ALT. Outcomes and perception of cloud-based remote patient monitoring in children receiving automated peritoneal dialysis: a prospective study. Pediatr Nephrol 2022:10.1007/s00467-022-05828-3. [PMID: 36449100 PMCID: PMC9709751 DOI: 10.1007/s00467-022-05828-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Remote patient monitoring (RPM) for automated peritoneal dialysis (APD) may improve clinical outcomes. Paediatric data, however, remain extremely scarce. METHODS We conducted a prospective observational study of children (0-18 years) receiving APD with cloud-based RPM over two 24-week periods (pre- and post-RPM). Primary outcomes were unplanned hospitalizations and fluid management. Children receiving APD without RPM (non-RPM) were included as control. RESULTS Seven patients (6 females) receiving APD were enrolled in the RPM programme at 11.3 years (IQR 2.6-17.1). Main indications for RPM included history of fluid overload (n = 3) and non-adherence (n = 2). Ten children were included in the non-RPM group (6 females; 16.9 years, IQR 12.8-17.6). Four patients (57.1%, 95% CI 22.5-100%) experienced fewer unplanned hospitalizations and 5 patients (71.4%, 95% CI 34.1-100%) had shorter hospital stays during the post-RPM period. The hospitalization rates and length of stay were reduced by 45% and 42%, respectively. The higher hospitalization rates among the RPM group, compared to the non-RPM group, were no longer observed following implementation of RPM. There was a significant increase in ultrafiltration (565.6 ± 248.7 vs. 501.7 ± 286.6 ml/day, p = 0.03) and reduction in systolic blood pressure (114.1 ± 12.6 vs. 119.9 ± 11.19 mmHg, p = 0.02) during the post-RPM period. All patients demonstrated satisfactory adherence. Although quality of life (PedsQL 3.0 ESRD module) was not different pre- and post-RPM, all patients agreed in the questionnaires that the use of RPM improved their quality of life and sense of security. CONCLUSIONS In conclusion, RPM in children receiving APD is associated with fewer and shorter unplanned hospitalizations, improved fluid management and favourable adherence to PD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong SAR.
| | - Mei-Shan Liu
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong SAR
| | - Po-Chu Or
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong SAR
| | - Alison Lap-Tak Ma
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Kowloon City, Hong Kong SAR
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10
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Chan EYH, Yap DYH, Wong WT, Wong WHS, Wong SW, Lin KYK, Hui FYW, Yee-ming J, Lam SSY, Wong JKY, Lai FFY, Ho TW, Tong PC, Lai WM, Chan TM, Ma ALT. Long-Term Outcomes of Children and Adolescents With Biopsy-Proven Childhood-Onset Lupus Nephritis. Kidney Int Rep 2022; 8:141-150. [PMID: 36644360 PMCID: PMC9831948 DOI: 10.1016/j.ekir.2022.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Long-term data pertaining to childhood-onset lupus nephritis (cLN) remain extremely scarce. Methods We conducted a retrospective cohort study of biopsy-proven cLN with onset age <18 years diagnosed from 2001 to 2020 to ascertain the long-term patient and kidney survival rates, and the incidence of advanced chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m2). Results A total of 92 subjects (78 female; age 13.7 ± 3.3 years; all Chinese) were included, with follow-up duration of 10.3 years (interquartile range, 5.8-15.9). Of these, 83 children (90%) had proliferative lupus nephritis (LN) (Class III/IV ± V). Mycophenolate was used for induction in 36%, whereas 34% received cyclophosphamide (CYC); 55% received mycophenolate as maintenance immunosuppression. The rates of complete remission (CR) and partial remission (PR) at 6 months and 12 months, respectively, were 65% and 20% and 78% and 8%. Two patients died (mortality rate 2.1/1000 patient-years), with a standardized mortality ratio of 22.3. Three patients (3.2%) developed end-stage kidney disease (ESKD), and advanced CKD occurred in 5 patients (5.4%). Survival rates without advanced CKD, ESKD, or death were 96.7%, 94.2%, 92.7%, 83.2% and 83.2% at 1 year, 5 years, 10 years, 15 years, and 20 years, respectively. Multivariate analysis revealed that severe kidney failure necessitating dialysis at presentation (adjusted hazard ratio 37.7, 95% confidence interval [CI] 4.0-355.6, P = 0.002), nonresponse (NR) after 12 months of treatment (adjusted hazard ratio 11.2, 95% CI 2.3-54.9, P = 0.003), and multiple nephritis flares (adjusted hazard ratio 2.6, 95% CI 1.1-6.2, P = 0.03) were predictive of advanced CKD, ESKD, or death. Other adverse outcomes included infections (2.9 episodes/100 patient-years), osteopenia (32%), hypertension (17%), short stature (14%), and avascular necrosis (7%). Conclusion The long-term outcomes of cLN appeared to have improved in the present era with effective immunosuppression, cautious drug tapering, and assurance of medication adherence. There is still an unacceptably high prevalence of adverse outcomes.
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Affiliation(s)
- Eugene Yu-hin Chan
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong,Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Desmond Yat-hin Yap
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong,Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Wing-tung Wong
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Wilfred Hing-sang Wong
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Sze-wa Wong
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong
| | - Kyle Ying-kit Lin
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong
| | - Felix Yan-wai Hui
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong
| | - Jennifer Yee-ming
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong
| | | | | | | | - Tsz-wai Ho
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong
| | - Pak-chiu Tong
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong
| | - Wai-ming Lai
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong
| | - Tak Mao Chan
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong,Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong,Correspondence: Tak Mao Chan, Paediatric Nephrology Centre, Hong Kong Children's Hospital; Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
| | - Alison Lap-tak Ma
- Paediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong,Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong,Alison Lap-tak Ma, Pediatric Nephrology Center, Hong Kong Children’s Hospital, Hong Kong.
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