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Lao C, White D, Rabindranath K, Dantzig PV, Foxall D, Lawrenson R. Mortality and causes of death in systemic lupus erythematosus in New Zealand: a population-based study. Rheumatology (Oxford) 2024; 63:1560-1567. [PMID: 37632770 PMCID: PMC11147544 DOI: 10.1093/rheumatology/kead427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVES This study aims to assess the mortality of systemic lupus erythematosus (SLE) patients and examine whether there are variations by subgroup. METHODS SLE patients from 2005 to 2021 were identified from the national administrative datasets. The underlying causes of death were examined. Standardized mortality ratio (SMR) was estimated to compare the relative rate of observed deaths in SLE patients with expected deaths in the general population. The hazard ratios (HR) and 95% confidence intervals (CI) of all-cause mortality and SLE specific mortality by ethnicity were estimated after adjustment for age using a Cox proportional hazards model. RESULTS Of the 2802 patients included for analysis, 699 (24.9%) died with 209 (29.9%) SLE deaths. The age-standardized mortality rate of SLE was 0.29 per 100 000 for women and 0.05 for men. The mean age at death was 65.3 (17.1) years. Younger patients were more likely to have SLE as the underlying cause of death, from 78.9% for those under 20 years old to 18.7% for those aged 70-79 years. Compared with the general population, SLE patients were four times more likely to die (SMR: 4.0; 95% CI: 3.7, 4.3). Young patients had higher SMRs than older patients. Māori had worse all-cause mortality (HR: 1.72; 95% CI: 1.10, 2.67) and SLE specific mortality (HR: 2.60; 95% CI: 1.29, 5.24) than others. CONCLUSIONS The outcomes of SLE in New Zealand were still very poor compared with the general population. Māori with SLE had worse survival than others. Further research is needed to identify the reasons for this disparity.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
| | | | | | - Donna Foxall
- Te Huataki Waiora—School of Health, The University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Hamilton, New Zealand
- Strategy and Funding, Waikato Hospital, Hamilton, New Zealand
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Pan L, Liu J, Liu C, Guo L, Punaro M, Yang S. Childhood-onset systemic lupus erythematosus: characteristics and the prospect of glucocorticoid pulse therapy. Front Immunol 2023; 14:1128754. [PMID: 37638017 PMCID: PMC10448525 DOI: 10.3389/fimmu.2023.1128754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is an autoimmune disease that results in significant damage and often needs more aggressive treatment. Compared to adult-onset SLE, cSLE has a stronger genetic background and more prevalent elevated type I Interferon expression. The management of cSLE is more challenging because the disease itself and treatment can affect physical, psychological and emotional growth and development. High dose oral glucocorticoid (GC) has become the rule for treating moderate to severe cSLE activity. However, GC-related side effects and potential toxicities are problems that cannot be ignored. Recent studies have suggested that GC pulse therapy can achieve disease remission rapidly and reduce GC-related side effects with a reduction in oral prednisone doses. This article reviews characteristics, including pathogenesis and manifestations of cSLE, and summarized the existing evidence on GC therapy, especially on GC pulse therapy in cSLE, followed by our proposal for GC therapy according to the clinical effects and pathogenesis.
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Affiliation(s)
- Lu Pan
- Department of Pediatric Rheumatology, Immunology and Allergy, The First Hospital, Jilin University, Changchun, China
| | - Jinxiang Liu
- Department of Pediatric Rheumatology, Immunology and Allergy, The First Hospital, Jilin University, Changchun, China
| | - Congcong Liu
- Department of Pediatric Rheumatology, Immunology and Allergy, The First Hospital, Jilin University, Changchun, China
| | - Lishuang Guo
- Department of Pediatric Rheumatology, Immunology and Allergy, The First Hospital, Jilin University, Changchun, China
| | - Marilynn Punaro
- Pediatric Rheumatology, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Rheumatology, Texas Scottish Rite Hospital for Children, Houston, TX, United States
- Pediatric Rheumatology, Children’s Medical Center of Dallas, Dallas, TX, United States
| | - Sirui Yang
- Department of Pediatric Rheumatology, Immunology and Allergy, The First Hospital, Jilin University, Changchun, China
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Windpessl M, Odler B, Bajema IM, Geetha D, Säemann M, Lee JM, Vaglio A, Kronbichler A. Glomerular Diseases Across Lifespan: Key Differences in Diagnostic and Therapeutic Approaches. Semin Nephrol 2023; 43:151435. [PMID: 37945450 DOI: 10.1016/j.semnephrol.2023.151435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Glomerular diseases are common causes of chronic kidney disease in childhood, adolescence, and adulthood. The epidemiology of glomerular diseases differs between different age groups, with minimal change disease being the leading cause of nephrotic syndrome in childhood, while membranous nephropathy and focal segmental glomerulosclerosis are more common in adulthood. IgA vasculitis is also more common in childhood. Moreover, there is a difference in disease severity with more children presenting with a relapsing form of nephrotic syndrome and a more acute presentation of antineutrophil cytoplasmic antibody-associated vasculitis and concomitant glomerulonephritis, as highlighted by the higher percentage of cellular crescents on kidney biopsy specimens in comparison with older patients. There is also a female preponderance in antineutrophil cytoplasmic antibody-associated vasculitis and more children present with tracheobroncholaryngeal disease. This article aims to summarize differences in the presentation of different glomerular diseases that are encountered commonly by pediatric and adult nephrologists and potential differences in the management.
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Affiliation(s)
- Martin Windpessl
- Section of Nephrology, Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Balazs Odler
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom; Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ingeborg M Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcus Säemann
- 6th Medical Department, Nephrology and Dialysis, Clinic Ottakring, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
| | - Jiwon M Lee
- Division of Rare Disease Management, Korea Disease Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Augusto Vaglio
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Firenze, Nephrology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Andreas Kronbichler
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria.
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Yamamoto T, Matsushita S, Endo D, Shimada A, Dohi S, Kajimoto K, Yokoyama Y, Sato Y, Machida Y, Asai T, Amano A. Management of cardiovascular surgery in patients with systemic lupus erythematosus including thromboembolism and multiple organ failure prevention: A retrospective observational study. Medicine (Baltimore) 2023; 102:e32979. [PMID: 36800570 PMCID: PMC9936021 DOI: 10.1097/md.0000000000032979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Systemic lupus erythematosus is a chronic autoimmune disease that affects most tissues. Cardiovascular events are critical, life-threatening, long-term complications of systemic lupus erythematosus (SLE). We report our single-center experience of performing cardiovascular surgery in patients with SLE while avoiding postoperative complications. We also suggest a new approach for cardiopulmonary bypass and perioperative management. We applied the antiphospholipid antibody syndrome (APS) severity classification published by the Japan Intractable Disease Information Center to patients with SLE for perioperative management. Patients with Grade III or higher severity are treated with a slightly relaxed version of catastrophic APS therapy. This treatment modality includes glucocorticoids, anticoagulation, intravenous immunoglobulin, and plasma exchange. Between April 2010 and January 2021, 26 patients (2 males, 24 females) with SLE underwent cardiovascular surgery. The mean age was 74.2 ± 13.0 years (38-84 years). The primary outcomes were in-hospital mortality and long-term results, and the secondary outcomes were related to bleeding/embolization and coagulation function/platelet count. A subset analysis was performed to examine treatment efficacy in the APS Grade III or higher group. Of the 26 patients, 17 underwent valve surgery, 4 underwent isolated coronary artery bypass grafting, and 5 underwent thoracic aortic aneurysm surgery. There were no in-hospital deaths or associated bleeding/embolic complications. Postoperative antithrombin III decreased in patients who underwent valvular and aortic surgery, and platelet counts recovered to preoperative levels within 7 to 10 days. The 5- and 10-year survival rates were 80.5% and 53.7%, respectively. In addition, there were 10 patients with APS Grade III or higher, but there was no significant difference in the frequency of complications other than platelet recovery after treatment. The surgical outcome of open-heart surgery in patients with SLE was good. Surgical treatment of cardiovascular disease in these patients is difficult and complex. We focused on blood coagulation abnormalities and treated each patient by selecting the best individual treatment protocol according to the severity of the disease, taking into account the risk of bleeding and thrombosis. Management of blood coagulation function in these patients is essential, and careful therapeutic management should be considered during open-heart surgery.
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Affiliation(s)
- Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
- * Correspondence: Taira Yamamoto, Department of Cardiovascular Surgery, Juntendo University Nerima Hospital, 3-1-10 Koyadai, Nerima-ku, Tokyo 177-8521, Japan (e-mail: )
| | | | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shizuyuki Dohi
- Department of Cardiovascular Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kan Kajimoto
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Yasutaka Yokoyama
- Department of Cardiovascular Surgery, Toda Chuo Hospital, Saitama, Japan
| | - Yuichiro Sato
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Yoichiro Machida
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
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Moroni G, Calatroni M, Ponticelli C. Severe lupus nephritis in the present days. FRONTIERS IN NEPHROLOGY 2022; 2:984613. [PMID: 37675028 PMCID: PMC10479763 DOI: 10.3389/fneph.2022.984613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/22/2022] [Indexed: 09/08/2023]
Abstract
Lupus nephritis (LN) is one of the most frequent and severe organ manifestations of systemic lupus erythematosus (SLE) that is a chronic autoimmune disease. Despite improvement in patient and renal prognosis, the disease continued to be associated with a high rate of end stage kidney disease. Along the last decades, it seems that the epidemiology of LN and its clinical presentation have progressively changed. The forms with renal insufficiency at presentation seem to have progressively reduced in developed countries in favour of more mild clinical presentations with urinary abnormalities only. To this clinical change does not correspond a less severe histological lesions, in fact, the extent of active lesions at kidney biopsy are unchanged, whereas chronic lesions are becoming less frequent and less severe. Meanwhile, new types of severe LN defined by the variable association of demographic, clinical, histological characteristics at diagnosis or during the follow-up are gradually emerging and require attention in assessing the therapy and prognosis. During the last years, randomized controlled trials have reported the efficacy of new drugs in association with standard therapy to improve the rate of short- and medium-term renal response. One of the advantages is that these results were obtained with reduced dosage of corticosteroids whose protracted use is associated with increase of chronic organ damage. Optimization of therapeutical strategies, tailored on the demographic clinical and histological characteristics, with combination of old and new drugs are urgently needed for severe LN.
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Affiliation(s)
- Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele Milan, Italy
- Nephrology and Dialysis Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele Milan, Italy
- Nephrology and Dialysis Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
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Hsu CY, Chiu WC, Huang YL, Su YJ. Identify differential inflammatory cellular and serology pathways between children and adult patients in the lupus registry. Medicine (Baltimore) 2022; 101:e29916. [PMID: 35960068 PMCID: PMC9371509 DOI: 10.1097/md.0000000000029916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Age variances in systemic lupus erythematosus (SLE) may reflect different patterns and consequences. Monocyte differentiation is critical, and cytokine and chemokine milieu may be associated with long term outcome and treatment responses. This study aims to evaluate the inflammatory cellular and serology pathways associated with age in our lupus registry. METHODS We included patients with SLE and divided them into 2 groups according to age, ≤18 or >18 years old. We performed flow cytometry analysis to define the peripheral blood monocyte differentiation pattern and phenotypes and used the multiplex method to detect cytokine and chemokine panels. The results were then compared between the 2 subgroups. RESULTS In total, 47 SLE patients were included in this study. Of those, 23 patients were 18 years old or younger, and 24 patients were over the age of 18 years old. An increased distribution of circulating Type 2b macrophage (M2b) subsets was found in patients over 18 years old (P < 0.01), and we found the Type 1 macrophage (M1) to demonstrate a marked increase in those patients ≤18 years old (P = .05). Eotaxin values were significantly higher in patients >18 years old (P = .03), and Macrophage Inflammatory Protein (MIP)-1alpha, MIP-1beta, Interleukine (IL)-1Ra, Interferon (IFN)-alpha2, IL-12, IL-13, IL-17A, IL-1beta, IL-2, IL-4, IL-5, IL-7, IL-9, Monocyte Chemoattractant Protein (MCP)-3, Transforming Growth Factor (TGF)-alpha, and Tumor necrosis factor (TNF)-beta were significantly higher in patients ≤18 years old (all P < .05). CONCLUSIONS We found significant M2b polarization in adult SLE patients, and several cytokines and chemokines were significantly higher in SLE patients ≤ 18 years old. Peripheral blood mononuclear cell differentiation and cytokine milieu could represent composite harm from both Type 2 helper T cells (Th2) and Type 17 helper T cells (Th17) pathways and may thus be a potential therapeutic target in younger SLE patients.
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Affiliation(s)
- Chung-Yuan Hsu
- Departments of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chan Chiu
- Departments of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Ling Huang
- Departments of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jih Su
- Departments of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- *Correspondence: Yu-Jih Su, Departments of Rheumatology, Allergy and Immunology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, No. 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung City 833, Taiwan (e-mail: )
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Longitudinal comparison of IL-6, IL-10, and IL-12 cytokine profiles in adult and childhood-onset systemic lupus erythematosus. J Transl Autoimmun 2022; 5:100158. [PMID: 36683864 PMCID: PMC9846463 DOI: 10.1016/j.jtauto.2022.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 01/25/2023] Open
Abstract
Objective To compare the levels of Th1 (IL-12) and Th2 (IL-6 and IL10) cytokines over a two-year period among systemic lupus erythematosus patients with childhood-onset (cSLE), adult-onset (sSLE), and healthy controls, and correlate with their clinical, laboratory, and treatment manifestations. Methods The study included 63 patients with cSLE [57 (90%) women; mean age 19.7 ± 4.3 years (range = 10-29); mean disease duration 7.3 ± 4.2 years (range 2-15)], 67 patients with aSLE [65 (97%) women; mean age of 39.9 ± 11.8 years (range 21-68); disease duration 7.7 ± 3.1 years (range 4-16)], and 40 healthy controls [36 (90%) women; mean age of 29.6 ± 10 years (range 12-49)]. cSLE and aSLE patients were paired by disease duration. Clinical and laboratory manifestations, disease activity (SLEDAI), cumulative damage (SDI), and current drug exposures were evaluated. Symptoms of anxiety and depression were evaluated by the Beck inventory (BAI and BDI, respectively). Th1 (IL-12) and Th2 (IL-6 and IL-10) cytokines were measured by the ELISA test. Data were collected at four different time points (TI, TII, TIII, and TIV) and compared by non-parametric tests. Results IL-6 levels were significantly higher in aSLE patients compared to healthy controls at times I, II, and III (TI p = 0.013, TII p = 0.015, TIII p = 0.004, and TIV p = 0.634). However, no difference was observed between cSLE patients and healthy controls (TI p = 0.223, TII p = 0.613, TIII p = 0.341, and TIV p = 0.977). In addition, no difference was observed between aSLE and cSLE patients (TI p = 0.377, TII p = 0.123, TIII p = 0.105, and TIV p = 0.591). The levels of IL-12 were significantly higher in cSLE patients compared to healthy controls at all time points (TI p = 0.04, TII p < 0.001, TIII p = 0.015, and TIV p = 0.021). aSLE patients showed significantly elevated levels when compared to healthy controls at time III and IV (TI p = 0.752, TII p = 0.827, TIII p = 0.011*, and TIV p < 0.001*). cSLE patients showed significantly higher levels than aSLE patients at times I and II (TI p = 0.07*, TII p < 0.001*, TIII p = 0.998, and TIV p = 0.140). In aSLE patients, IL-6 was associated with headache (p = 0.006), arthritis (p = 0.044), and nephritis (p = 0.012); IL-10 was associated with nephritis (p = 0.043), hypocomplementemia (p = 0.001), and disease activity (p = 0.001); in these patients, IL-12 was associated with alopecia (p = 0.025) and leukopenia (p = 0.044). In cSLE patients, IL-6 was associated with arthritis (p = 0.022) and malar rash (p = 0.012). Conclusion aSLE and cSLE patients with long disease duration present similar levels of cytokines, despite differences in clinical activity patterns over time.
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Clinical manifestations, prognosis, and treat-to-target assessment of pediatric lupus nephritis. Pediatr Nephrol 2022; 37:367-376. [PMID: 34379208 PMCID: PMC8816762 DOI: 10.1007/s00467-021-05164-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/09/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pediatric lupus nephritis (pLN) is one of the most refractory secondary kidney diseases in childhood. The treat-to-target (T2T) strategy has become the standard treatment for systemic lupus erythematosus (SLE). This study reviewed clinical features, overall remission status, and factors affecting prognosis, to guide pLN management according to T2T strategy. METHODS This single-center retrospective study studied 220 children diagnosed with LN from January 2012 to December 2018, with > 6-month follow-up data on 173 and complete data on 137 patients. Primary outcome was treatment failure (deterioration or no response) at the latest follow-up. RESULTS The most common pLN manifestation was proteinuria (81.36%). Females presented more often with rash (P<0.001) and alopecia (P=0.026) than males. Class IV LN (33.33%) was the most common grade on kidney biopsy. Median follow-up was 27.20 months (IQR, 15.78-44.45 months). One-, 3-, and 5-year cumulative overall survival rates were 93.5%, 87.8%, and 86.5%, respectively. The 5-year cumulative kidney survival rate was 97.1%. Regarding initial therapy, efficacy of corticosteroids combined with immunosuppressive agents was significantly better than corticosteroids alone (P=0.010). Factors with P<0.05 in univariate analysis, including hypoalbuminemia, higher SCr at diagnosis, lower eGFR at diagnosis, anti-dsDNA positivity, heavy proteinuria, hypertension, nervous-system involvement, treatment non-compliance, and SLEDAI-2K score, were used for logistic regression analysis. Logistic regression analysis showed hypertension (OR=0.845, P=0.011), nervous-system involvement (OR=4.240, P=0.005), treatment non-compliance (OR=6.433, P=0.001), and lower estimated glomerular filtration rate at diagnosis (OR=1.020, P=0.021) affected prognosis. At end of follow-up, 34.31% achieved varying levels of remission, and 8.76% were in low disease activity state (LDAS). CONCLUSIONS pLN usually presented with proteinuria, and class IV LN was the dominant pathology. Hypertension, nervous-system involvement, treatment non-compliance, and lower eGFR at diagnosis were independent risk factors for poor prognosis of kidney outcomes. Compared with renal remission rate and cumulative overall survival rate, the proportion of targets achieved was not ideal, suggesting T2T strategy should be used to guide pLN management. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Shabaka A, Landaluce-Triska E, Sánchez-Álvarez JE, Fernández-Juárez G. Changing trends in presentation and indications of biopsy in lupus nephritis: data from the Spanish Registry of Glomerulonephritis. Clin Kidney J 2021; 15:703-708. [PMID: 35371447 PMCID: PMC8967535 DOI: 10.1093/ckj/sfab236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background With the ageing population and changes in the indications of diagnostic and protocol biopsies in systemic lupus erythematosus in recent years, an impact on the incidence and presentation of lupus nephritis (LN) is expected. The aim of this study was to analyse the epidemiological changes regarding clinical and histological presentation of LN in kidney biopsies performed from 1994 to 2019 included in the Spanish Registry of Glomerulonephritis. Methods We analysed data from 28 791 kidney biopsies from 130 Spanish hospitals comparing demographic, clinical and histological data. We divided the cohort according to the age of onset of LN into pediatric onset (<18 years), adult onset (18–50 years) and late onset (>50 years). Results The incidence of LN has decreased from 9.6% of all kidney biopsies in the period 1994–2013 to 7% in the last quarter of the observation period (2014–2019) (P < 0.001), despite an increase in the proportion of patients with LN that underwent repeat biopsies (16.6–24%; P < 0.001). The age of onset of LN has increased from 32 ± 14 to 38 ± 14 years (P < 0.001), with an increase in the proportion of late-onset LN (from 13% to 22% of incident LN; P < 0.001). There were no differences in the distribution of histological features at presentation over the study period. Patients with late-onset LN showed fewer gender differences, had lower GFR and presented with less-proliferative forms of LN compared with early-onset LN. Conclusions The frequency of biopsy-proven LN has been decreasing in recent years, despite an increasing number of repeat biopsies. Late-onset LN is increasing, presenting with worse kidney function but fewer proliferative lesions compared with younger-onset LN.
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Affiliation(s)
- Amir Shabaka
- Nephrology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Yousef AA, Mohamed FY, Boraey NF, Akeel NE, Soliman AA, Waked NM, Hashem MIA, Shehata H, Fahmy DS, Ismael A, Ibrahim LM, Ibrahim MAM, Salem HF, Yousry SM, Osman SF, Fouad RA, Enan ET, Attia MA, Afify MR, Zeidan NMS, Nashat M. Association of Plasminogen Activator Inhibitor 1 (PAI-1) 4G/5G Polymorphism and Susceptibility to SLE in Egyptian Children and Adolescents: A Multicenter Study. J Inflamm Res 2020; 13:1103-1111. [PMID: 33363394 PMCID: PMC7754263 DOI: 10.2147/jir.s277373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/27/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Plasminogen activator inhibitor-1 (PAI-1) is a key molecule residing at the nexus between thrombosis and inflammatory processes. Recently, PAI-1 and its gene expression have emerged as a potential candidate for autoimmune disorders such as SLE. OBJECTIVE To investigate whether the PAI-1 4G/5G polymorphism at position -675 could be a genetic marker for susceptibility to childhood-onset SLE and development of lupus nephritis among Egyptian children and adolescents. METHODS Three hundred fifty patients diagnosed with childhood-onset SLE and 350 well-matched healthy controls were included in this multi-center study. All subjects were genotyped for the PAI-1 promoter 4G/5G polymorphism at position -675 using PCR- restriction fragment length polymorphism (RFLP). Serum PAI-1 levels were measured by ELISA. RESULTS The PAI-1 (- 675) 4G/4G genotype was more represented in c-SLE patients, as compared to the control group (38% vs 23%; OR =2.7; [95% CI: 1.47-2.9]; P < 0.001). Patients carrying the PAI-1 4G/4G genotype or 4G allele were more likely to develop lupus nephritis (OR: 3.38; [95% CI: 1.9-5.9]; P <0.001, for the 4G/4G genotype and OR: 2.6; [95% CI: 1.85-3.67]; for the 4G allele; P < 0.01). The PAI-1 4G/4G genotype was associated with higher PAI-1 serum concentrations (mean; 86.6±22.7 ng/mL) as compared to those with a 4G/5G genotype (mean; 48.3±16.5 ng/mL) and the lowest for the 5G/5G genotype (mean; 34.7±11.4 ng/mL); P = 0.004. CONCLUSION The PAI-1 4G/5G polymorphism may confer susceptibility to childhood-onset SLE and development of lupus nephritis among Egyptian children and adolescents. Moreover, the PAI-1 4G/4G genotype and 4G allele were associated with higher PAI-1 serum levels and higher disease activity scores.
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Affiliation(s)
- Aly A Yousef
- Department of Pediatrics, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Faisal Y Mohamed
- Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Naglaa F Boraey
- Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Nagwa E Akeel
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Attia A Soliman
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nevin M Waked
- Department of Pediatrics, Faculty of Medicine, October 6 University, October 6, Egypt
| | - Mustafa I A Hashem
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hassan Shehata
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dalia S Fahmy
- Department of Rheumatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Ismael
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Lamya M Ibrahim
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed A M Ibrahim
- Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hanan F Salem
- Department of Anesthesia, Faculty of Medicine, Banha University, Banha, Egypt
| | - Sherif M Yousry
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherif F Osman
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Rania A Fouad
- Department of Medical Biochemistry, College of Medicine, El-Mareefa University, Riyadh, Kingdom of Saudi Arabia
- Department of Medical Biochemistry, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman T Enan
- Department of Pathology, College of Medicine, El-Mareefa University, Riyadh, Kingdom of Saudi Arabia
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Mohammed A Attia
- Department of Clinical Pharmacology, College of Medicine, El-Mareefa University, Riyadh, Kingdom of Saudi Arabia
- Department of Clinical Pharmacology, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Mona R Afify
- Department of Medical microbiology and Parasitology, Faculty of Medicine, University of Jeddah, Jeddah, 21589, Saudia Arabia
| | - Nancy M S Zeidan
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Nashat
- Department of Pediatrics, Faculty of Medicine, Aswan University, Aswan, Egypt
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11
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Arnaud L, Tektonidou MG. Long-term outcomes in systemic lupus erythematosus: trends over time and major contributors. Rheumatology (Oxford) 2020; 59:v29-v38. [PMID: 33280012 PMCID: PMC7719040 DOI: 10.1093/rheumatology/keaa382] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/03/2020] [Indexed: 12/20/2022] Open
Abstract
SLE is a chronic autoimmune rheumatic disorder of high heterogeneity in clinical presentation, treatment response and prognosis. Long-term outcomes in SLE have been dramatically improved over the past decades, however, increased morbidity and mortality, especially among young individuals, still exists. Unmet needs include residual disease activity and frequent flares, glucocorticoid treatment dependency and toxicity, comorbidity burden, reduced health-related quality of life, health disparities and damage. The main determinants of long-term outcomes in SLE are age, sex, race/ethnicity, genetic profile, environmental factors including smoking, disease activity, major organ involvement such as lupus nephritis and CNS involvement, comorbidities including cardiovascular disease and serious infections, coexistence with APS, treatment adherence, socio-economic factors and access to care. In this review we discuss trends in long-term outcomes in SLE over the years and major contributors such as genetic, disease-related, treatment, comorbidity, socio-economic and other factors.
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Affiliation(s)
- Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg, INSERM UMR-S 1109, Centre National de Référence des Maladies Auto-immunes Systémiques Rares (RESO), Strasbourg, France
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Joint Rheumatology Program, Laiko Hospital, Athens, Greece
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12
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Akca UK, Ayaz NA. Comorbidities of antiphospholipid syndrome and systemic lupus erythematosus in children. Curr Rheumatol Rep 2020; 22:21. [DOI: 10.1007/s11926-020-00899-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Elkoumi MA, Allah MA, Mohamed FY, Boraey NF, Abdellatif SH, Shehab MM, Sherif AH, Akeel NE, Saleh RM, Elshreif AM, Abdelrahman HM, Soliman AA, Emam AA, Youssef MA, Fahmy DS, Sallam MM, Nawara AM, Elgohary EA, Ismael A, El-Kaffas SM, Sobeih AA, Ibrahim LM, Ibrahim MA, Abdou AM, Yousry SM, Osman SF, El-Deeb FM, Elhewala AA, Hafez SF, Waked NM, Elbasyouni HA, Fouad RA, Zeidan NM, Nashat M, Farghaly MA. Association of interleukin-17A gene polymorphisms and susceptibility to systemic lupus erythematosus in Egyptian children and adolescents: a multi-centre study. Lupus 2020; 29:767-775. [PMID: 32380889 DOI: 10.1177/0961203320922305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recently, the interleukin-17A (IL-17A) gene has emerged as a potential candidate gene for autoimmune disorders, including systemic lupus erythematosus (SLE). OBJECTIVES This study aimed to investigate whether IL-17A polymorphisms at rs2275913 G/A, rs8193036 C/T and rs3748067 C/T could be susceptibility markers for juvenile-onset SLE (JSLE) and lupus nephritis (LN) in Egyptian children and adolescents. METHODS In this multi-centre study, we genotyped 320 patients diagnosed with JSLE and 320 matched control children for three IL-17A polymorphisms at rs2275913 G/A, rs8193036 C/T and rs3748067 C/T using TaqMan probe-based real-time polymerase chain reaction. Meanwhile, IL-17A serum levels were assessed using ELISA. RESULTS The IL-17 rs2275913 A/A genotype and A allele were more represented in JSLE patients compared to the control group (21% vs. 7%, odds ratio (OR) = 3.8, 95% confidence interval (CI) 1.78-5.5, p = 0.001, pBonf = 0.003 for the A/A genotype; 37% vs. 29%, OR = 1.4, 95% CI 1.11-1.8, p = 0.003, pBonf = 0.009 for the A allele. No significant difference was found for IL-17 rs8193036 and rs3748067 single nucleotide polymorphisms (SNPs) in genotype distribution or allele frequencies (p>0.05). Patients carrying the IL-17 rs2275913 A/A genotype and A allele were more likely to develop LN (OR = 5.64, 95% CI 2.39-13.77, pBonf = 0.001 for the A/A genotype; OR = 2.73, 95% CI 1.84-4.07, pBonf = 0.02 for the A allele). CONCLUSION The IL-17 rs2275913 A allele and A/A genotype were associated with high IL-17 serum levels and may contribute to susceptibility to JSLE and the development of LN in Egyptian children and adolescents. However, no significant association was evident between the studied IL-17A SNPs and other clinical phenotypes, disease activity scores or laboratory profile of JSLE.
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Affiliation(s)
- Mohamed A Elkoumi
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Mayy An Allah
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Faisal Y Mohamed
- Department of Paediatrics, Faculty of Medicine, Ain-Shams University, Egypt
| | - Naglaa F Boraey
- Department of Paediatrics, Faculty of Medicine, Sohag University, Egypt
| | | | - Mohamed Mm Shehab
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Ahmed H Sherif
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Nagwa E Akeel
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Rabab M Saleh
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Anas M Elshreif
- Department of Paediatrics, Faculty of Medicine, Al Azhar University, Egypt
| | - Hind M Abdelrahman
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Attia A Soliman
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Ahmed A Emam
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Manal Aa Youssef
- Department of Rheumatology, Faculty of Medicine, Zagazig University, Egypt
| | - Dalia S Fahmy
- Department of Rheumatology, Faculty of Medicine, Zagazig University, Egypt
| | - Mohammad M Sallam
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | - Abdalla M Nawara
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | - Elsayed A Elgohary
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | - Ali Ismael
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
| | | | - Alaa A Sobeih
- Department of Paediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Lamya M Ibrahim
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
| | - Mohamed Am Ibrahim
- Department of Clinical Pathology, Faculty of Medicine, Sohag University, Egypt
| | - Adel M Abdou
- Department of Clinical Pathology, Faculty of Medicine, Al Azhar University, Egypt
| | - Sherif M Yousry
- Department of Clinical pathology, Faculty of Medicine, Cairo University, Egypt
| | - Sherif F Osman
- Department of Radiology, Texas Tech University Health Sciences Center El Paso, USA
| | - Fatma M El-Deeb
- Department of Dermatology, Faculty of Medicine, Zagazig University, Egypt
| | - Ahmed A Elhewala
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Sahbaa Fm Hafez
- Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Nevin M Waked
- Department of Paediatrics, Faculty of Medicine, October 6 University, Egypt
| | - Hany Aa Elbasyouni
- Department of Internal Medicine, Faculty of Medicine, Menoufia University, Egypt
| | - Rania A Fouad
- Department of Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt
| | - Nancy Ms Zeidan
- Department of Paediatrics, Faculty of Medicine, Cairo University, Egypt
| | - Mohamed Nashat
- Department of Paediatrics, Faculty of Medicine, Aswan University, Egypt
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14
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Santos SS, Ramos CM, Monteiro MLGDR, Machado JR, Reis MAD, Corrêa RRM, Rocha LP. Mast cells in the kidney biopsies of pediatric patients with lupus nephritis. ACTA ACUST UNITED AC 2020; 42:59-66. [PMID: 32023339 PMCID: PMC7213939 DOI: 10.1590/2175-8239-jbn-2018-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 10/15/2019] [Indexed: 11/24/2022]
Abstract
Introduction: Mast cells may be involved in inflammation and contribute to the onset of
fibrosis in lupus nephritis (LN). Objective: This study aimed to correlate the presence of mast cells in kidney biopsy
specimens of pediatric patients with LN with activity (AI) and chronicity
(CI) indices and assess how effectively mast cells may be used as a
prognostic factor. Method: The study included 40 patients aged 6-18 years diagnosed with LN at the
Renal Disease Service of the Federal University of Triângulo Mineiro between
1996 and 2015. Workup and epidemiological data were evaluated vis-à-vis AI,
CI, and mast cell counts (MCC). Results: Significant positive correlations were found between mast cell counts (MCC)
and AI (p = 0.003; r: 0.66) and MCC and CI
(p = 0.048; r: 0.48). The ROC curve showed that mast
cells were highly sensitive and specific in the differentiation of patients
with an AI > 12 from individuals with an AI ≤ 12. Serum creatinine levels
were higher in individuals with class IV LN than in patients with class V
disease [1.50 (0.40-20.90) vs. 0.70 (0.62-0.90), p = 0.04].
Blood urea nitrogen had a positive significant correlation with MCC
(p = 0.002; r: 0.75). A trend toward a negative
correlation was observed between MCC and serum albumin (p =
0.06; r: -0.5459). Kidney biopsies of patients with nephrotic syndrome had
higher MCC [2.12 (0.41-5.140) vs. 0.53 (0.0-3.94), p =
0.07]. Conclusion: Inflammatory cell infiltration and morphological differences between cell
types in the inflammatory infiltrate are relevant factors in the assessment
of the LN. Mast cell analysis and AI/CI assessment may be relevant
prognostic indicators for pediatric patients with LN.
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Affiliation(s)
- Stéfany Silva Santos
- Departamento de Patologia Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Carolina Marques Ramos
- Departamento de Patologia Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | | | - Juliana Reis Machado
- Departamento de Patologia Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Marlene Antônia Dos Reis
- Departamento de Patologia Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Rosana Rosa Miranda Corrêa
- Departamento de Patologia Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Laura Penna Rocha
- Departamento de Patologia Genética e Evolução, Instituto de Ciências Biológicas e Naturais, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
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15
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Hao GX, Song LL, Zhang DF, Su LQ, Jacqz-Aigrain E, Zhao W. Off-label use of tacrolimus in children with glomerular disease: Effectiveness, safety and pharmacokinetics. Br J Clin Pharmacol 2020; 86:274-284. [PMID: 31725919 DOI: 10.1111/bcp.14174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022] Open
Abstract
Glomerular diseases are leading causes of end-stage renal disease in children. Tacrolimus is frequently used off-label in the treatment of glomerular diseases. The effectiveness, safety and pharmacokinetic data of tacrolimus in the treatment of glomerular diseases in children are reviewed in this paper to provide evidence to support its rational use in clinical practice. The remission rates in previously published studies were different. In 19 clinical trials on children with nephrotic syndrome, the overall remission rate was 52.6-97.6%. In four clinical trials on children with lupus nephritis, the overall remission rate was 81.8-89.5%. In a pilot study with paediatric Henoch-Schönlein purpura nephritis patients, the overall remission rate was 100.0%. Infection, nephrotoxicity, gastrointestinal symptoms and hypertension are the most common adverse events. Body weight, age, CYP3A5 genotype, cystatin-C and daily dose of tacrolimus may have significant effects on the pharmacokinetics of tacrolimus in children with glomerular disease. More prospective controlled trials with long follow-up are needed to demonstrate definitely the effectiveness, safety and pharmacokinetics of tacrolimus in children with glomerular diseases.
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Affiliation(s)
- Guo-Xiang Hao
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Lin-Lin Song
- Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Dong-Feng Zhang
- Department of Pediatric Nephrology, Children's Hospital of Hebei Province affiliated to Hebei Medical University, Shijiazhuang, China
| | - Le-Qun Su
- Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Evelyne Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, APHP, Paris, France
| | - Wei Zhao
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China.,Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan, China
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16
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Zhang CX, Cai L, Zhou ZY, Mao YY, Huang H, Yin L, Chen TX, Zhou W. Clinical manifestations, immunological features and prognosis of Chinese pediatric systemic lupus erythematosus: A single-center study. Int J Rheum Dis 2019; 22:1070-1076. [PMID: 30957986 DOI: 10.1111/1756-185x.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM Since there are only a few reports on pediatric systemic lupus erythematosus (pSLE) in Chinese populations, therefore we retrospectively report the clinical and immunological features as well as renal outcome in Chinese pSLE. METHODS Patients diagnosed with pSLE at Shanghai Children's Medical Center between 2001 and 2016 were evaluated and clinical data were retrospectively collected. RESULTS A total of 102 pSLE patients were analyzed. Renal disorder including proteinuria (81.37%) and hematuria (65.69%) were most commonly identified. Class IV was the most common finding on renal biopsy. In lupus nephritis (LN), 67.21%, 78.0%, 86.0% and 94.55% achieved complete remission within 6, 12, 18 and 24 months, respectively. Furthermore, 16.67% of LN patients suffered at least one renal flare. Antinuclear antibodies were detected in nearly all patients (97.62%), followed by anti-double-stranded DNA (anti-dsDNA) antibodies (70.0%) and anti-Sjögren's syndrome A (anti-SSA) antibodies (60.64%). Oral corticosteroid (93.14%) and mycophenolate mofetil (64.71%) was used in the majority of patients. Infection (32.35%) was the main side effect caused by the medications. CONCLUSIONS Our population-based pSLE cohort indicated that compared to other international cohorts, there was a higher prevalence of LN in Chinese pSLE. Proteinuria was the most frequent manifestation both at disease onset and during the entire clinical course. Class IV LN was the dominant renal pathological type. Nevertheless, there was a favorable renal remission rate and relatively low incidence of renal flare in our cohort. Apart from antinuclear antibodies and anti-dsDNA antibodies, anti-SSA antibodies were most frequently detected. Infection was the leading complication caused by the medications.
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Affiliation(s)
- Chen-Xing Zhang
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Cai
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zheng-Yu Zhou
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - You-Ying Mao
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hua Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Yin
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tong-Xin Chen
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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17
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Cildag S, Kara Y, Cakir E, Cildag MB, Senturk T. Comparison of Clinical and Laboratory Findings in Patients with Systemic Lupus Erythematosus with Regard to Age at Onset. Eurasian J Med 2019; 51:17-21. [PMID: 30911250 DOI: 10.5152/eurasianjmed.2018.18022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/22/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Systemic lupus erythematosus (SLE) rarely has a late onset. Late-onset SLE (LSLE) has a milder course and less organ involvement. The purpose of the present study was to compare the clinical and laboratory (lab) findings of SLE regarding age at onset. Materials and Methods Seventy-two patients with SLE were included in the study. The age at onset was considered adult-onset SLE (ASLE) if it was <50 years and LSLE if it was ≥50 years. Lab parameters and clinical findings were compared accordingly. Results Overall, 41 (56.9%) patients had ASLE, and 31 (43.05%) patients had LSLE based on the age at onset. The ratio of female-to-male patients was higher in ASLE, and no significant difference was found with regard to gender distribution (12.6:1 and 5.2:1 for ASLE and LSLE, respectively; p=0.239). While malar rash and fever were more common in ASLE, no difference was found regarding the other clinical findings. Only IgG anti-cardiolipin was more common in LSE between the lab parameters. Conclusion Although it is known that LSLE has a milder course and less organ involvement, there are differences in clinical and lab findings and organ involvement in various studies. The results of our study showed no significant difference in organ involvement between ASLE and LSLE.
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Affiliation(s)
- Songul Cildag
- Department of Immunology-Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Yasemin Kara
- Department of Immunology-Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ersin Cakir
- Department of Internal Medicine, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Mehmet Burak Cildag
- Department of Radiology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Taskin Senturk
- Department of Immunology-Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
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18
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Brunner HI, Gulati G, Klein-Gitelman MS, Rouster-Stevens KA, Tucker L, Ardoin SP, Onel KB, Mainville R, Turnier J, Aydin POA, Witte D, Huang B, Bennett MR, Devarajan P. Urine biomarkers of chronic kidney damage and renal functional decline in childhood-onset systemic lupus erythematosus. Pediatr Nephrol 2019; 34:117-128. [PMID: 30159624 PMCID: PMC6294330 DOI: 10.1007/s00467-018-4049-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/20/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To delineate urine biomarkers that reflect kidney structural damage and predict renal functional decline in pediatric lupus nephritis (LN). METHODS In this prospective study, we evaluated kidney biopsies and urine samples of 89 patients with pediatric LN. Urinary levels of 10 biomarkers [adiponectin, ceruloplasmin, kidney injury molecule-1, monocyte chemotactic protein-1, neutrophil gelatinase-associated lipocalin, osteopontin, transforming growth factor-ß (TGFß), vitamin-D binding protein, liver fatty acid binding protein (LFABP), and transferrin] were measured. Regression analysis was used to identify individual and combinations of biomarkers that determine LN damage status [NIH-chronicity index (NIH-CI) score ≤ 1 vs. ≥ 2] both individually and in combination, and biomarker levels were compared for patients with vs. without renal functional decline, i.e., a 20% reduction of the glomerular filtration rate (GFR) within 12 months of a kidney biopsy. RESULTS Adiponectin, LFABP, and osteopontin levels differed significantly with select histological damage features considered in the NIH-CI. The GFR was associated with NIH-CI scores [Pearson correlation coefficient (r) = - 0.49; p < 0.0001] but not proteinuria (r = 0.20; p > 0.05). Similar to the GFR [area under the ROC curve (AUC) = 0.72; p < 0.01], combinations of osteopontin and adiponectin levels showed moderate accuracy [AUC = 0.75; p = 0.003] in discriminating patients by LN damage status. Renal functional decline occurred more commonly with continuously higher levels of the biomarkers, especially of TGFß, transferrin, and LFABP. CONCLUSION In combination, urinary levels of adiponectin and osteopontin predict chronic LN damage with similar accuracy as the GFR. Ongoing LN activity as reflected by high levels of LN activity biomarkers heralds renal functional decline. KEY MESSAGES • Levels of osteopontin and adiponectin measured at the time of kidney biopsy are good predictors of histological damage with lupus nephritis. • Only about 20% of children with substantial kidney damage from lupus nephritis will have an abnormally low urine creatinine clearance. • Continuously high levels of biomarkers reflecting lupus nephritis activity are risk factors of declining renal function.
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Affiliation(s)
- Hermine I. Brunner
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MC 4010, Cincinnati, OH 45229, USA
| | - Gaurav Gulati
- Division of Allergy and Rheumatology, Department of Medicine, University of Cincinnati, Cincinnati, USA
| | - Marisa S. Klein-Gitelman
- Department of Pediatrics, Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Kelly A. Rouster-Stevens
- Division of Rheumatology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, Canada
| | - Stacey P. Ardoin
- Division of Rheumatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, USA
| | - Karen B. Onel
- Division of Pediatric Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Rylie Mainville
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica Turnier
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MC 4010, Cincinnati, OH 45229, USA
| | - Pinar Ozge Avar Aydin
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MC 4010, Cincinnati, OH 45229, USA
| | - David Witte
- Division of Pathology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital and Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Michael R. Bennett
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MC 4010, Cincinnati, OH 45229, USA,Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MC 4010, Cincinnati, OH 45229, USA,Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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19
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Wright RD, Beresford MW. Podocytes contribute, and respond, to the inflammatory environment in lupus nephritis. Am J Physiol Renal Physiol 2018; 315:F1683-F1694. [PMID: 30207171 PMCID: PMC6336988 DOI: 10.1152/ajprenal.00512.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lupus nephritis (LN) affects up to 80% of juvenile onset systemic lupus erythematosus patients, leading to end stage renal failure requiring dialysis or transplantation in 10-15%. Podocytes are specialized epithelial cells of the glomerulus known to be a key site of damage in glomerular diseases. However, their roles in LN have yet to be fully identified. This project aims to identify structural and functional roles of podocytes in an in vitro model of LN. Conditionally immortalized podocytes were treated with proinflammatory cytokines (IL-1β, TNF-α, IFN-α, and IFN-γ) alone and in combination in an in vitro model of LN and were assessed for their structural and functional characteristics. Podocytes produce TNF-α, IL-6, IL-8, VEGF, granulocyte-monocyte colony stimulating factor (GM-CSF), and macrophage colony stimulating factor (M-CSF) at relatively low levels under basal conditions; stimulation with IL-1β led to increased secretion of IL-6 ( P = 0.011), IL-8 ( P = 0.05), VEGF ( P = 0.02), and M-CSF ( P = 0.03). Stimulation with TNF-α led to increased secretion of M-CSF ( P = 0.049) and stimulation with IFN-γ led to novel production of IL-10 ( P = 0.036) and interferon-γ-inducible protein-10 ( P = 0.036). Podocytes demonstrate a reduction in the area covered by filamentous-actin in response to IL-1β treatment within 1 h ( P = 0.011), which is restored by 24 h, associated with an increase in the level of intracellular calcium but not with increased cell death. Podocytes contribute to the inflammatory milieu in LN through cytokine/chemokine secretion and respond to the inflammatory milieu via rearrangement of the actin cytoskeleton leading to effacement, a well-known method of protection against apoptosis in these cells. This demonstrates that podocytes are involved in the pathogenesis of LN.
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Affiliation(s)
- Rachael D Wright
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool , Liverpool , UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust , Liverpool , UK
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Almutairi A, Alkathiri Z, Al-Mayouf SM. Combination of tacrolimus and mycophenolate mofetil in persistent proteinuria due to refractory childhood lupus nephritis. Int J Pediatr Adolesc Med 2018; 5:99-102. [PMID: 30805542 PMCID: PMC6363263 DOI: 10.1016/j.ijpam.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/26/2018] [Accepted: 08/05/2018] [Indexed: 01/27/2023]
Abstract
Background Children with lupus nephritis particularly, diffuse proliferative and membranous glomerulonephritis, may necessitate potent immunosuppressive medications and occasionally combined therapy. Objective To report the beneficial effects of tacrolimus (TAC) in children with refractory lupus nephritis from a single tertiary pediatric rheumatology clinic. Methods This is a retrospective case series of children with refractory lupus nephritis treated with TAC after failure of aggressive immunosuppressive treatment. All patients were evaluated at the time of initiation of TAC and at last follow-up visit by assessing the following response parameters: cSLE Disease Activity Index (SLEDAI), urine protein/creatinine ratio, urine sediments, serum albumin, complement (C3 and C4), anti-double-stranded DNA (dsDNA) antibody levels, and renal function assessed by glomerular filtration rate (eGFR). Results Three children (two girls and one boy) with lupus nephritis and persistent nephrotic-range proteinuria failed prednisone treatment as well as sequential treatment of cyclophosphamide, mycophenolate mofetil (MMF), and rituximab. When TAC was administered along with MMF and prednisone, all patients showed improvement in response parameters, namely, SLEDAI, serum albumin, and proteinuria, and prednisone doses were significantly weaned off and discontinued in two patients. However, eGFR remained stable during the treatment period. TAC was well tolerated, and no adverse effects were observed. Conclusion TAC combined with MMF can be considered as an alternative therapeutic option for children with refractory lupus nephritis particularly those with persistent nephrotic-range proteinuria.
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Affiliation(s)
- Abdulaziz Almutairi
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ziyad Alkathiri
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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21
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Zhang CX, Chen J, Cai L, Wu J, Wang JY, Cao LF, Zhou W, Chen TX. DNA induction of MDM2 promotes proliferation of human renal mesangial cells and alters peripheral B cells subsets in pediatric systemic lupus erythematosus. Mol Immunol 2018; 94:166-175. [PMID: 29324237 DOI: 10.1016/j.molimm.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/11/2017] [Accepted: 01/04/2018] [Indexed: 02/06/2023]
Abstract
The study is aimed to investigate the role of MDM2 in the pathogenesis of lupus nephritis (LN) in pediatric SLE (pSLE). We confirmed that MDM2 expression was increased in peripheral blood mononuclear cells (PBMCs) as well as renal specimen of SLE compared with that of controls by western blot and immunofluorescence staining. Percentage of apoptotic and necrotic CD4+T, CD8+T and B cells were detected by flow cytometry respectively and levels of plasma cell free DNA (cfDNA) were quantified in SLE and healthy controls (HC). We also proved that elevated apoptotic and necrotic CD4+T cells were the main cause for increased plasma levels of cfDNA in pSLE. Additionally, upon DNA transfection MDM2 increased while P53 and P21 decreased in human renal mesangial cells (HRMC), with concomitant increase in proliferation rate and proportion of cells in S phase, as demonstrated by cell proliferation assay and cell cycle analysis. However, MDM2 inhibition reversed the trend. Furthermore, percentage of switched memory B cells decreased and proportion of double negative B cells increased upon blockage of MDM2 in PBMC. In summary, our study provided the first evidence that DNA induction of MDM2 promotes proliferation of HRMC and alters peripheral B cells subsets in pSLE. Thus our study has not only elucidated the pathogenesis of MDM2 in pediatric LN but also provided a novel target for drug development. In conclusion, our data suggested that apoptosis, cfDNA and MDM2 could form a pathological axis in SLE, especially in pSLE.
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Affiliation(s)
- Chen-Xing Zhang
- Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ji Chen
- Department of Dermatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Li Cai
- Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jing Wu
- Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jia-Yuan Wang
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lan-Fang Cao
- Department of Pediatrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Wei Zhou
- Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Tong-Xin Chen
- Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Department of Nephrology and Rheumatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
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Kang JH, Park DJ, Lee KE, Lee JS, Choi YD, Lee SS. Comparison of clinical, serological, and prognostic differences among juvenile-, adult-, and late-onset lupus nephritis in Korean patients. Clin Rheumatol 2017; 36:1289-1295. [DOI: 10.1007/s10067-017-3641-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/17/2017] [Indexed: 12/31/2022]
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23
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Artim-Esen B, Şahin S, Çene E, Şahinkaya Y, Barut K, Adrovic A, Özlük Y, Kılıçaslan I, Omma A, Gül A, Öcal L, Kasapçopur Ö, İnanç M. Comparison of Disease Characteristics, Organ Damage, and Survival in Patients with Juvenile-onset and Adult-onset Systemic Lupus Erythematosus in a Combined Cohort from 2 Tertiary Centers in Turkey. J Rheumatol 2017; 44:619-625. [PMID: 28298568 DOI: 10.3899/jrheum.160340] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
Objective.Age at onset has been shown to affect the clinical course and outcome of systemic lupus erythematosus (SLE). Herein, we aimed to define the differences in clinical characteristics, organ damage, and survival between patients with juvenile-onset (jSLE) and adult-onset SLE (aSLE).Methods.For the study, 719 patients (76.9%) with aSLE and 216 (23.1%) with jSLE were examined. Comparisons between the groups were made for demographic characteristics, clinical features, auto-antibody profiles, damage, and survival rates.Results.These results were significantly more frequent in jSLE: photosensitivity, malar rash, oral ulcers, renal involvement, neuropsychiatric (NP) manifestations, and autoimmune hemolytic anemia (AIHA). Of the autoantibodies, a higher frequency of anti-dsDNA and anticardiolipin IgG and IgM were observed in the jSLE group. A significant proportion of patients with aSLE had anti-Sm positivity and pleuritis. The proportion of patients with jSLE who developed organ damage was comparable to that of patients with aSLE (53% vs 47%) and the mean damage scores were similar in both groups. Renal damage was significantly more frequent in jSLE while musculoskeletal and cardiovascular system damage and diabetes mellitus were more prominent in aSLE. Comparison of survival rates of the 2 groups did not reveal any significant differences.Conclusion.We report a higher frequency in the jSLE group of renal involvement, cutaneous symptoms, oral ulcers, NP manifestations, AIHA, and anti-dsDNA positivity. A significant proportion of patients in the jSLE group had damage, most prominently in the renal domain. Our findings might support different genetic/environmental backgrounds for these 2 subgroups.
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Tanaka H, Joh K, Imaizumi T. Treatment of pediatric-onset lupus nephritis: a proposal of optimal therapy. Clin Exp Nephrol 2017; 21:755-763. [PMID: 28258497 DOI: 10.1007/s10157-017-1381-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/05/2017] [Indexed: 02/01/2023]
Abstract
Lupus nephritis (LN) is one of the major clinical manifestations of systemic lupus erythematosus (SLE) which occurs frequently in the early stages of pediatric-onset cases. Since SLE is a chronic disease associated with frequent disease flares and effective and safe maintenance therapy is required for achieving a favorable outcome, optimal treatment for LN in pubertal patients is a great challenge that remains to be overcome. Although its etiology remains unclear, it has been reported that the innate and adaptive immune systems have been reported to play an important role in the pathogenesis of SLE. However, studies of drugs that have been useful in controlling inflammatory pathways mediated by the innate and adaptive immune systems are now underway. In clinical practice, recent advances in the management of LN, together with earlier renal biopsy and selective use of aggressive immunosuppressive therapy, have contributed to a favorable outcome in children and adolescents with LN. However, the balance of the efficacy of treatment in terms of long-term prognosis and its adverse effects should be weighed in determining the treatment strategy.
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Affiliation(s)
- Hiroshi Tanaka
- Department of School Health Science, Faculty of Education, Hirosaki University, Hirosaki, 036-8650, Japan. .,Department of Pediatrics, Hirosaki University Hospital, Hirosaki, 036-8563, Japan.
| | - Kensuke Joh
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Tadaatsu Imaizumi
- Department of Vascular Biology, Graduate School of Medicine, Hirosaki University, Hirosaki, 036-8562, Japan
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25
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Sassi RH, Hendler JV, Piccoli GF, Gasparin AA, da Silva Chakr RM, Brenol JCT, Monticielo OA. Age of onset influences on clinical and laboratory profile of patients with systemic lupus erythematosus. Clin Rheumatol 2016; 36:89-95. [PMID: 27858177 DOI: 10.1007/s10067-016-3478-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/12/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023]
Abstract
The present study aims to evaluate differences in clinical and laboratory manifestations and medication use in the different ages of disease onset in patients with systemic lupus erythematosus (SLE). This cross-sectional study consisted of 598 SLE patients (550 female and 48 male), who attended the Rheumatology Clinic of the Hospital de Clínicas de Porto Alegre between 2003 and 2015. Demographic, clinical and laboratory data were collected. The patients were classified into three groups according to their ages at disease diagnosis. Mean age of diagnosis was 33.6 ± 14.3 years, and the median (25th-75th percentile) disease duration was 13 (7-20) years. Among the patients studied, 419 (70%) were adult-onset (aSLE), 90 (14.8%) were late-onset (lSLE) and 89 (14.8%) were childhood-onset (cSLE). The female to male ratio was higher in aSLE (18:1) compared to the other groups (p = 0.001). Arthritis was predominantly found in aSLE (78.5%) when compared with lSLE (57.7%) (p < 0.001). Nephritis was more common in cSLE (60.6%) than in lSLE (26.6%) (p < 0.001). Median (25th-75th percentile) of SLE disease activity index (SLEDAI) was higher in the cSLE group [2 (0-5)] when compared to the lSLE group [0 (0-4)] (p = 0.045). Childhood-onset SLE showed a more severe disease due to the higher incidence of nephritis and needed a more aggressive treatment with immunosuppressive drugs.
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Affiliation(s)
- Rafael Hennemann Sassi
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul UFRGS, Rua Ramiro Barcelos, 2350, 645, Porto Alegre, 90035-003, Brazil
| | - Jordana Vaz Hendler
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul UFRGS, Rua Ramiro Barcelos, 2350, 645, Porto Alegre, 90035-003, Brazil
| | - Giovana Fagundes Piccoli
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul UFRGS, Rua Ramiro Barcelos, 2350, 645, Porto Alegre, 90035-003, Brazil
| | - Andrese Aline Gasparin
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul UFRGS, Rua Ramiro Barcelos, 2350, 645, Porto Alegre, 90035-003, Brazil
| | - Rafael Mendonça da Silva Chakr
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul UFRGS, Rua Ramiro Barcelos, 2350, 645, Porto Alegre, 90035-003, Brazil
| | - João Carlos Tavares Brenol
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul UFRGS, Rua Ramiro Barcelos, 2350, 645, Porto Alegre, 90035-003, Brazil
| | - Odirlei André Monticielo
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul UFRGS, Rua Ramiro Barcelos, 2350, 645, Porto Alegre, 90035-003, Brazil.
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26
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Adelowo OO, Olaosebikan BH, Animashaun BA, Akintayo RO. Juvenile systemic lupus erythematosus in Nigeria. Lupus 2016; 26:329-333. [DOI: 10.1177/0961203316672927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Juvenile systemic lupus erythematosus (JSLE) is a complex multisystemic autoimmune disorder of unknown cause. It accounts for about one in five cases of SLE. The tendency for SLE to run a fulminant course when it starts in childhood has made JSLE a potentially more severe disease than adult SLE. Reports of JSLE from sub-Saharan Africa are scanty in spite of the increasing reports of adult SLE. We conducted a 4-year retrospective study of JSLE cases seen at the Lagos State University Teaching Hospital between January 2010 and December 2014. Out of the 12 patients studied, eight were girls and four were boys. All patients had positive antinuclear antibody and extractable nuclear antibody tests. Anti-dsDNA antibody was positive in 10 patients. Eight patients had renal disease while four patients had neuropsychiatric manifestations. Haematological abnormalities and constitutional symptoms were present in all patients. Patients were treated with pulse methylprednisolone, oral prednisolone, hydroxychloroquine and azathioprine. Three patients also received rituximab. In conclusion, JSLE exists in Nigeria and exhibits clinical and immunological characteristics similar to its pattern in other parts of the world. It is, however, diagnosed late and is possibly being underdiagnosed as there is no paediatric rheumatologist in the country.
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Affiliation(s)
- O O Adelowo
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - B H Olaosebikan
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - B A Animashaun
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - R O Akintayo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Wu CY, Yang HY, Yao TC, Liu SH, Huang JL. Serum IL-18 as biomarker in predicting long-term renal outcome among pediatric-onset systemic lupus erythematosus patients. Medicine (Baltimore) 2016; 95:e5037. [PMID: 27749566 PMCID: PMC5059068 DOI: 10.1097/md.0000000000005037] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
An urge of biomarker identification is needed to better monitor lupus nephritis (LN) disease activity, guide clinical treatment, and predict patient's long-term outcome. With the proinflammatory effect and its association with inflammasomes, the significance of interleukin-18 (IL-18) among pediatric-onset systemic lupus erythematous (pSLE) patient, especially, its importance in predicting long-term renal outcome was investigated.In a pSLE cohort of 96 patients with an average follow-up period of 10.39 ± 3.31 years, clinical data and laboratory workups including serum IL-18 were collected at time of disease onset and 6 months after treatment despite their initial renal status. Through Cox regression analysis, the parameters at baseline and at 6 months posttreatment were carefully analyzed.Average age of all cases was 12.74 ± 3.01 years old and 65 of them underwent renal biopsy at the time of diagnosis. Nine subjects (9.38%) progressed to end-stage renal disease (ESRD) and 2 cases (2.08%) died during follow-up. Through multivariate analysis, serum IL-18 level 6 months posttreatment was found to be the most unfavorable factor associating poor clinical outcome despite patient's initial renal status. In addition, the presentation of serum IL-18 in its correlation with SLE global disease activity as well as the presence and severity of LN were all significant (P < 0.001, P = 0.03, and P = 0.02, respectively). The histological classification of LN, however, was not associated with the level of IL-18 among the pSLE patients (P = 0.64).The role of serum IL-18 as biomarker representing global disease activity and status of renal flares among pSLE population was shown for the first time. Additionally, we have identified IL-18 at 6 months posttreatment a novel marker for long-term renal outcome prediction.
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Affiliation(s)
- Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Chang Gung Children's Hospital
- Chang Gung University, College of Medicine
| | - Huang-Yu Yang
- Chang Gung University, College of Medicine
- Department of Nephrology
| | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Chang Gung Children's Hospital
- Chang Gung University, College of Medicine
| | - Su-Hsun Liu
- Chang Gung University, College of Medicine
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Allergy, Asthma, and Rheumatology, Chang Gung Children's Hospital
- Chang Gung University, College of Medicine
- Correspondence: Jing-Long Huang, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (e-mail: )
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28
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Ambrose N, Morgan TA, Galloway J, Ionnoau Y, Beresford MW, Isenberg DA. Differences in disease phenotype and severity in SLE across age groups. Lupus 2016; 25:1542-1550. [PMID: 27147622 PMCID: PMC5089221 DOI: 10.1177/0961203316644333] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/21/2016] [Indexed: 12/15/2022]
Abstract
Objectives Significant differences have been reported in disease phenotype and severity of systemic lupus erythematosus (SLE) presenting in different age groups. Most indicate a more severe phenotype in juvenile-onset SLE (JSLE). There have been limited studies in older patients and no large studies looking at SLE across all age groups. Methods We assessed the effect of age of onset of SLE on the clinical phenotype by analysing data from two large UK cohorts (the UK JSLE Cohort and the UCLH SLE cohort). Results A total of 924 individuals were compared (413 JSLE, 511 adult-onset SLE). A female preponderance was present, but less pronounced at either end of the age spectrum. Arthritis was more common with advancing age (93% vs 72%, p < 0.001), whereas renal disease (44% vs 33%, p = 0.001), alopecia (47% vs 23%, p < 0.001) and aphthous ulcerations (39% vs 26%, p = 0.001) were more common in the young. Neuropsychiatric lupus was less common in mature-onset SLE (p < 0.01). JSLE was associated more commonly with thrombocytopenia (21% vs 15%, p = 0.01), haemolytic anaemia (20% vs 3%, p < 0.001), high anti-dsDNA (71% vs 63%, p = 0.009), Sm (22% vs 16%, p = 0.02) and RNP (36% vs 29%, p < 0.04) auto-antibodies. Leucopenia increased with advancing age (p < 0.001). Mortality has been declining over recent decades. However, death rates were substantially higher than the general population. The standardized mortality ratio was 18.3 in JSLE and 3.1 in adult-onset SLE. Conclusion These data from the largest-ever direct comparison of JSLE with adult-onset SLE suggest an aggressive phenotype of disease with a worse outcome in patients with JSLE and emphasizes the importance of careful follow-up in this population.
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Affiliation(s)
- N Ambrose
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK .,Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UK
| | - T A Morgan
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK .,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
| | - J Galloway
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK
| | - Y Ionnoau
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UK
| | - M W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, UK
| | - D A Isenberg
- Centre for Rheumatology, University College London (UCL) Hospital NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UK
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Al-Mayouf SM, AlSaleem A, Al-Hussain T, Al Sonbul A, AlMana H. The impact of antiphospholipid antibodies in children with lupus nephritis. Int J Pediatr Adolesc Med 2015; 2:147-151. [PMID: 30805454 PMCID: PMC6372390 DOI: 10.1016/j.ijpam.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/14/2015] [Indexed: 11/30/2022]
Abstract
Background and objectives To evaluate the frequency of antiphospholipid antibodies (APLa) among patients with childhood lupus nephritis (cLN) and to assess their impact on long-term renal outcomes. Design and setting This is an observational hospital based study. Patients and methods Patients with cLN diagnosed by renal biopsy seen between January 2002 and June 2014 were included. APLa positivity was defined if detection was positive on 2 occasions 6-12 weeks apart during their follow up. Demographic features, age at disease onset, disease duration, follow-up duration and clinical and laboratory variables at the time of renal biopsy were collected. The renal biopsy was reviewed for the nephritis class, microthrombi, activity and chronicity indices. Renal outcome measures included the serum creatinine levels, protein/creatinine ratio and end stage renal disease (ESRD). Results Fifty-nine, (49 female) patients with a mean age of 19.8 years and mean disease duration of 6.8 years were involved. APLa were detected in 46 (78%) patients. Twenty-two patients had class IV nephritis, which was more prevalent in APLa positive patients. The frequencies of class III and V nephritis was similar in 10 patients in each class (7 patients in each class with APLa). The presence of APLa did not correlate with nephritis activity or the chronicity indices. Microthrombosis was found in 10 patients, and 8 of them had APLa. Patients with APLa had a higher frequency of elevated serum creatinine and hypertension, 9 developed ESRD, and 7 had APLa. There was no statistically significant association between the presence of APLa and the accrual damage index and clinical manifestations. Furthermore, there was no association between APLa and other autoantibodies. Conclusion The frequency of APLa in cLN was high. While the association is not statistically significant, APLa positive patients tend to develop renal microthrombi and are probably at higher risk of ESRD.
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Affiliation(s)
- Sulaiman M Al-Mayouf
- Departments of Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alhanouf AlSaleem
- Departments of Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Turki Al-Hussain
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Al Sonbul
- Departments of Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hadeel AlMana
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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30
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Rianthavorn P, Buddhasri A. Long-term renal outcomes of childhood-onset global and segmental diffuse proliferative lupus nephritis. Pediatr Nephrol 2015; 30:1969-76. [PMID: 26054714 DOI: 10.1007/s00467-015-3138-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Data on global (IV-G) and segmental (IV-S) diffuse proliferative lupus nephritis (DPLN) in children are lacking. METHODS To determine the clinicopathology and prognosis of DPLN subclasses IV-G and IV-S, we analyzed the clinical, laboratory, and demographic data of 56 children aged <18 years diagnosed with DPLN [36 (64.3%) with IV-G; 20 (35.7%) with IV-S] between 2004 and 2013. Clinical endpoints were: (1) complete remission (CR), (2) chronic kidney disease [CKD; defined as estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m(2) or end-stage renal disease (ESRD)], and (3) death. RESULTS Proteinuria and the activity index were higher in patients with IV-G (p < 0.05). Global endocapillary proliferation and leukocyte exudation were predominant in IV-G patients, whereas segmental endocapillary proliferation was predominant in patients with IV-S (p < 0.005). CR rates in IV-G and IV-S patients were 50 and 60%, respectively (p = 0.47). Renal survival rates, defined as an eGFR of ≥60 mL/min/1.73 m(2), were 93, 78, and 64% at 1, 5, and 10 years, respectively. Patient survival rates at 1, 5, and 10 years were 98, 96, and 91%, respectively. Patient and renal survival rates were similar in both subclasses. CONCLUSIONS Although patients with IV-G and IV-S displayed some clinical and histopathological disparities, renal outcomes were similar. The majority of children with DPLN reached adulthood but accrued significant renal damage. Treatment regimens which can slow the progression of CKD are needed.
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Affiliation(s)
- Pornpimol Rianthavorn
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, 1873 King Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Athitaya Buddhasri
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, 1873 King Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
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das Chagas Medeiros MM, Bezerra MC, Braga FNHF, da Justa Feijão MRM, Gois ACR, Rebouças VCDR, de Carvalho TMAZ, Carvalho LNS, Ribeiro ÁM. Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adult-onset, and late-onset SLE. Lupus 2015; 25:355-63. [PMID: 26405022 DOI: 10.1177/0961203315606983] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022]
Abstract
The clinical expression of systemic lupus erythematosus (SLE) is influenced by genetic and environmental factors and therefore varies between ethnicities. Information on the epidemiology of SLE in Brazil is scarce and practically limited to studies conducted in socioeconomically developed regions (South and Southeast). The objective of this study was to describe the clinical and immunological aspects and outcome of a cohort of patients with SLE treated at a university hospital in northeastern Brazil and compare patterns related to age at onset: childhood (cSLE), adult (aSLE), and late (lSLE). A random sample of 414 records (women: 93.5%) were reviewed. The mean age at SLE onset and the mean disease duration were 28.9 ± 10.9 years and 10.2 ± 6.6 years, respectively. Most patients had aSLE (n = 338; 81.6%), followed by cSLE (n = 60; 14.5%) and lSLE (n = 16; 3.9%). The female/male ratio was 6.5:1 in cSLE and 16.8:1 in aSLE; in lSLE, all patients were female (p = 0.05). During follow-up, the cSLE group presented higher rates of nephritis (70% vs. 52.9% vs. 12.5%; p = 0.0001) and leuko/lymphopenia (61.7% vs. 43.8% vs. 56.2%; p = 0.02). No significant differences were found for anti-dsDNA, anti-Sm, and antiphospholipid antibodies. Treatment with immunosuppressants was significantly more common, and higher doses of prednisone were used, in cSLE. The prevalence of cardiovascular diseases were more frequent in lSLE (p = 0.03). No significant differences were found between the three groups with regard to mean damage accrual (SDI), remission, and mortality. Although cSLE presented higher rates of nephritis and leuko/lymphopenia, more frequent use of immunosuppressants and higher prednisone doses than aSLE and lSLE, the three groups did not differ significantly with regard to damage accrual, remission, and mortality.
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Chen YM, Lin CH, Chen HH, Chang SN, Hsieh TY, Hung WT, Hsieh CW, Lai KL, Lan JL, Chen DY, Lan TH. Onset age affects mortality and renal outcome of female systemic lupus erythematosus patients: a nationwide population-based study in Taiwan. Rheumatology (Oxford) 2014; 53:180-185. [DOI: 10.1093/rheumatology/ket330] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Feng X, Zou Y, Pan W, Wang X, Wu M, Zhang M, Tao J, Zhang Y, Tan K, Li J, Chen Z, Ding X, Qian X, Da Z, Wang M, Sun L. Associations of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus. Lupus 2013; 23:327-34. [PMID: 24297642 DOI: 10.1177/0961203313513508] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study is to evaluate the association of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus (SLE) in a large, multicenter Chinese cohort. Medical records of 1898 SLE inpatients from 15 hospitals were reviewed and classified into three groups according to their ages at disease presentation. Categorical data were analyzed by chi-square test and potentially associated factors were tested by multinomial logistic regression. Among the patients studied, 259 (13.6%) were juvenile onset (≤18 years), 1444 (76.1%) were early onset (>18 and ≤45 years) and 195 (10.3%) were late onset (>45 years). Whenever manifestations occurred, most patients (>80%) were diagnosed within two years. Juvenile-onset patients were more likely to be untreated before admission ( p < 0.001) and have mucocutaneous manifestations ( p < 0.001), but musculoskeletal symptoms ( p < 0.05) and leukopenia ( p < 0.05) were less frequent, while comorbidities were much higher in patients with late-onset SLE ( p < 0.001). Neuropsychiatric, cardiopulmonary, renal and gastrointestinal involvement, disease activity index and damage scores were similar among three groups. Anti-Sm antibodies were less prevalent in late-onset patients ( p < 0.05) and antimalarial drugs were more often applied to juvenile-onset patients ( p < 0.001). As expected, mortality was elevated in the late-onset SLE group ( p < 0.05), in which nearly half died of infections, which was much higher than those in the other two groups ( p < 0.001). Logistic regression confirmed that patients with juvenile- and early-onset disease were associated with high incidence of being untreated prior to admission, and with low incidence of comorbidities as well as deaths caused by infection compared to patients with late-onset lupus. Interestingly, our data showed that more patients with late-onset disease had a SLEDAI score change of >7 at discharge. In conclusion, age at onset has an impact on SLE disease status, and infection is the main cause of death in those with late-onset lupus. Considering that the late-onset patients had simultaneously easily controllable diseases and high incidence of comorbidities, a different treatment strategy from younger patients should be considered.
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Affiliation(s)
- X Feng
- Department of Rheumatology, Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Y Zou
- Department of Rheumatology, Wuxi People's Hospital, China
| | - W Pan
- Department of Rheumatology, Huaian No.1 Hospital, China
| | - X Wang
- Department of Rheumatology, Xuzhou No.4 People’s Hospital, China
| | - M Wu
- Department of Rheumatology, the 3rd Affiliated Hospital of Suzhou University, China
| | - M Zhang
- Department of Rheumatology, Jiangsu Provincial People's Hospital, China
| | - J Tao
- Department of Rheumatology, Wuxi Chinese Traditional Medicine Hospital, China
| | - Y Zhang
- Department of Rheumatology, Subei People‘s Hospital of Jiangsu province, China
| | - K Tan
- Department of Rheumatology, Zhenjiang No.1 People’s Hospital, China
| | - J Li
- Department of Rheumatology, Affiliated hospital of Jiangsu University, China
| | - Z Chen
- Department of Rheumatology, the First Hospital of Suzhou University, China
| | - X Ding
- Department of Rheumatology, Lianyungang No.1 People’s Hospital, China
| | - X Qian
- Department of Rheumatology, Chinese Traditional Medicine Hospital of Jiangsu Province, China
| | - Z Da
- Department of Rheumatology, Affiliated Hospital of Nantong University, China
| | - M Wang
- Department of Rheumatology, Zhongda Hospital of Southeast University, China
| | - L Sun
- Department of Rheumatology, Affiliated Drum Tower Hospital of Nanjing University Medical School, China
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Morgan TA, Watson L, McCann LJ, Beresford MW. Children and adolescents with SLE: not just little adults. Lupus 2013; 22:1309-19. [DOI: 10.1177/0961203313502863] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Juvenile-onset systemic lupus erythematosus (JSLE) represents 15–20% of all SLE cases. Whilst features of this chronic complex multisystem autoimmune disorder are highly variable, children and adolescents generally present with a more severe illness than adults and accrue greater disease damage over time. JSLE has a less striking female preponderance and differs from the adult form in pattern of major organ manifestations. Corticosteroids are used in almost all children with JSLE along with the majority requiring additional immunosuppressive medications. Making the diagnosis early and optimizing disease control are essential to ensure that normal childhood and adolescent development is not impeded. In this young population, special consideration must be given to the long-term sequelae of the disease and treatment-related toxicity. There is a current lack of paediatric-specific controlled trials and treatment strategies are generally guided by adult data. The enormous psychological and social impact of the disease and its treatments upon the child or young person and their family necessitates a comprehensive, holistic, specialized multidisciplinary approach to managing JSLE.
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Affiliation(s)
- TA Morgan
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, UK
| | - L Watson
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, UK
| | - LJ McCann
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, UK
| | - MW Beresford
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, UK
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Wu JY, Yeh KW, Huang JL. Early predictors of outcomes in pediatric lupus nephritis: focus on proliferative lesions. Semin Arthritis Rheum 2013; 43:513-20. [PMID: 23972330 DOI: 10.1016/j.semarthrit.2013.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/20/2013] [Accepted: 07/08/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Studies regarding the clinical features and outcomes of pediatric lupus nephritis are limited, and risk factors of poor outcome in the more severe form of renal involvement, proliferative lupus nephritis (PLN), are poorly understood. This study analyzed the data from a large prospective cohort of childhood systemic lupus erythematosus to determine such risk factors. METHODS Subjects younger than 18 years at onset with biopsy-proven lupus nephritis were enrolled. Data on baseline presentations and laboratory values, response to treatment, and outcomes were collected. Primary outcome measures were death or end-stage renal disease (ESRD). Survival analysis was done and predictors were approached. RESULTS One hundred four patients with mean age of 12.4 ± 2.5 years (range, 4.0-17.2 years) and the female-to-male ratio of 5.94:1 were included. Among them, 81 patients had PLN and 23 had non-proliferative lupus nephritis. Those with PLN had significantly lower GFR, more proteinuria, more urine sediment, more hypertension, and poor early response to treatment (within 6 months). There was no significant difference in extra-renal manifestations. All poor outcomes happened in the PLN group. The prognostic factors were high baseline SLEDAI-2k >20 (HR, 6.76; p = 0.002), baseline GFR <60ml/min/m² (HR, 3.88; p = 0.022), and early responder (HR, 0.19; p = 0.013). CONCLUSIONS Patients with pediatric lupus nephritis and high risk factor can be identified early by concomitantly considering their baseline features and early response, which provides a novel hint in decision for management decisions.
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Affiliation(s)
- Jhong-Yong Wu
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, 5, Fu-Hsin St, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, 5, Fu-Hsin St, Taoyuan, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, 5, Fu-Hsin St, Taoyuan, Taiwan.
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Mina R, Brunner HI. Update on differences between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Res Ther 2013; 15:218. [PMID: 23998441 PMCID: PMC3978647 DOI: 10.1186/ar4256] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease and occurs worldwide in both children and adults. The estimated annual incidence among children is 2.22/100,000 and among adults is 23.2/100,000 in the United States. There is increasing understanding about differences in disease manifestations, medication use, and disease severity between those with childhood-onset SLE as compared with adult-onset SLE. Children have a more fulminant disease onset and course than adults with SLE, resulting in two to three times higher mortality. In future years, we anticipate more insight into the genetics between childhood-onset SLE and adult-onset SLE to help delineate the best therapies for both subsets of patients.
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Miettunen PM, Pistorio A, Palmisani E, Ravelli A, Silverman E, Oliveira S, Alessio M, Cuttica R, Mihaylova D, Espada G, Pasic S, Insalaco A, Ozen S, Porras O, Sztajnbok F, Lazarevic D, Martini A, Ruperto N. Therapeutic approaches for the treatment of renal disease in juvenile systemic lupus erythematosus: an international multicentre PRINTO study. Ann Rheum Dis 2012; 72:1503-9. [PMID: 23100607 DOI: 10.1136/annrheumdis-2012-201937] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate therapeutic approaches and response to therapy in juvenile systemic lupus erythematosus (SLE) with renal involvement in a large prospective international cohort from four geographic areas. METHODS New onset and flared patients with active renal disease (proteinuria ≥0.5 g/24 h) were enrolled in 2001-2004. Therapeutic approaches and disease activity parameters were analysed at baseline, 6, 12 and 24 months. Response was assessed by the PRINTO/ACR criteria. RESULTS 218/557 (79.8% female subjects, 117 new onset and 101 flared) patients with active renal disease were identified; 66 patients were lost to follow-up and 11 died. Mean age at disease onset for new onset group was higher than for flared group (13.1 vs 10.2 years, p<0.0001). At baseline, both groups had similar renal activity with similar median doses of corticosteroids (1.0-0.76 mg/kg/day). Cyclophosphamide (43.1%) and azathioprine (22%) were the most common immunosuppressive drugs. At baseline, South American patients received higher doses of corticosteroids than in other areas in new onset (median 1.16 vs 0.8-1 mg/kg/day) while cyclophosphamide use was similar in all four regions in the new onset group. There were no differences regarding the use of azathioprine or mycophenolate mofetil worldwide. PRINTO 70 response was reached in a greater percentage of new onset versus flared patients (74.8% vs 53.3%; p=0.005) at 6 months while at 24 months ACR 90 was reached by 69.9% and 56.1%, respectively. CONCLUSIONS New onset and flared juvenile SLE improved similarly over 24 months with minimal differences in therapeutic approaches worldwide.
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Affiliation(s)
- Paivi M Miettunen
- Division of Pediatric Rheumatology, University of Calgary, Alberta Children's Hospital, Calgary, Canada
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