Predictor of Rapidly Progressive Glomerulonephritis in Pediatric SLE
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Abstract
Background: SLE is a chronic autoimmune disease that can affect multiorgan, including the kidney. Lupus nephritis affects more than 50% of pediatric patients with SLE in 2-5 years. Children have more active and severe, in particular lupus nephritis, when compared to adult. The high mortality attributed to Rapidly Progressive Glomerulonephritis (RPGN) of SLE in children may be due to delays in diagnosis and treatment. The predictor of RPGN in Pediatric SLE in Thailand is still unknown.
Objective: To study the predictor factors, which are affected and associated with RPGN in Pediatric SLE
Methods: This retrospective cohort study with medical records of 62 patients under 15 years old whose diagnosed Systemic Lupus Erythematosus under Systemic Lupus International Collaborating clinic (SLICC 2012) criteria at Surin Hospital in Surin province from January, 2012 until March, 2021.The Study compared 2 groups: Without RPGN group consisted of 48 case and RPGN group consists of14case.Data analyzed using STATA 15.1 to identify the clinical and lab as predictor factors between 2 groups (Multivariated analysis, Adjusted Odds ratio, 95% Confidence Interval และ p-value <0.05).
Results: In total, 62 SLE patient data were evaluated in without RPGN group(77.4%) and RPGN group (22.6%). The average age of each group was 10.9 (±2.7) years in without RPGN and 11.3 (±3.2) years in RPGN group. Most were female. The most common initial manifestations were renal and Hemolytic anemia (78.5%) in RPGN group, compare to Acute cutaneous lupus and Hemolytic anemia (72.9%) in without RPGN group. Edema (71.4%) and hypertension (64.2%) were found significantly in RPGN group. Among without RPGN group found oral/nasal ulcer (56.2%) and alopecia (25 %) significantly. In RPGN group found Glomerular Hematuria (78.5%) (p-value 0.043), Proteinuria (71.4%), Mean BUN32.92 mg/dL (p-value 0.002), serum Creatinine2.03 mg/dL (p-value 0.007), GFR 60.18 (p-value 0.001). We evaluated European Consensus Lupus Activity Measurement Index (ECLAM), score 4.8 in without RPGN and 6.6 in RPGN group(p value 0.0001). Of the Univariate analysis in this study, predictor factors that affect RPGN are Edema, Oral ulcer, alopecia, Hypertension esp Diastolic BP more than80 mmHg Glomerular hematuria >100 /HPF and Nephrotic nephritis urine. Multivariate analysis were performed significantly OR 27.88 (95% CI 1.12-591.31) predictor factors of RPGN was serum Creatinine> 1 mg/dL at time of diagnosis.
Conclusion: Prediction model analysis reported that serum Creatinine> 1 mg/dL factor at first diagnosis of SLE can predicted Rapidly progressive glomerulonephritis.
Keywords: Pediatric-onset Systemic Lupus Erythematosus, SLE, Lupus Nephritis, Rapidly progressive glomerulonephritis, RPGN
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References
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