Acute kidney injury requiring kidney replacement therapy in childhood lupus nephritis: a cohort study of the Pediatric Nephrology Research Consortium and Childhood Arthritis and Rheumatology Research Alliance.

Publisher: Springer International Country of Publication: Germany NLM ID: 8708728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-198X (Electronic) Linking ISSN: 0931041X NLM ISO Abbreviation: Pediatr Nephrol Subsets: MEDLINE

Publication: Berlin : Springer International
Original Publication: Berlin : Springer International, c1987-

Lupus Nephritis*/complications ; Lupus Nephritis*/therapy ; Lupus Nephritis*/diagnosis ; Nephrology* ; Rheumatology* ; Arthritis, Juvenile*/complications ; Acute Kidney Injury*/epidemiology ; Acute Kidney Injury*/etiology ; Acute Kidney Injury*/therapy; Adult ; Child ; Humans ; Female ; Adolescent ; Male ; Cohort Studies ; Retrospective Studies ; Renal Dialysis ; Fibrosis ; Atrophy/complications

Background: Acute kidney injury (AKI) is common in lupus nephritis (LN) and a risk factor for development of chronic kidney disease. In adults with LN, AKI severity correlates with the incidence of kidney failure and patient survival. Data on AKI outcomes in children with LN, particularly those requiring kidney replacement therapy (KRT), are limited.
Methods: A multicenter, retrospective cohort study was performed in children diagnosed between 2010 and 2019 with LN and AKI stage 3 treated with dialysis (AKI stage 3D). Descriptive statistics were used to characterize demographics, clinical data, and kidney biopsy findings; treatment data for LN were not included. Logistic regression was used to examine the association of these variables with kidney failure.
Results: Fifty-nine patients (mean age 14.3 years, 84.7% female) were identified. The most common KRT indications were fluid overload (86.4%) and elevated blood urea nitrogen/creatinine (74.6%). Mean follow-up duration was 3.9 ± 2.9 years. AKI recovery without progression to kidney failure occurred in 37.3% of patients. AKI recovery with later progression to kidney failure occurred in 25.4% of patients, and there was no kidney recovery from AKI in 35.6% of patients. Older age, severe (> 50%) tubular atrophy and interstitial fibrosis, and National Institutes of Health (NIH) chronicity index score > 4 on kidney biopsy were associated with kidney failure.
Conclusions: Children with LN and AKI stage 3D have a high long-term risk of kidney failure. Severe tubular atrophy and interstitial fibrosis at the time of AKI, but not AKI duration, are predictive of kidney disease progression. A higher resolution version of the Graphical abstract is available as Supplementary information.
(© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

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P30 AR076316 United States AR NIAMS NIH HHS

Keywords: Acute kidney injury; Childhood lupus nephritis; Dialysis; Kidney replacement therapy; Systemic lupus erythematosus

Date Created: 20221017 Date Completed: 20230331 Latest Revision: 20230717

20230717

10.1007/s00467-022-05775-z

36251074