关键词: 狼疮性肾炎, 缓解, 预后, 儿童

Abstract:

Objective To analyze the clinical features of children with lupus nephritis (LN) and the factors affecting curative effect and prognosis. Methods The clinical data of children with LN who were newly diagnosed in the nephrology department from July 1, 2010 to December 31, 2019 were retrospectively analyzed. Results Ninety-eight children (19 boys and 79 girls) with LN were included, and the mean age of onset was (11.0±2.0) years. Of the 98 children with LN, 91 were accompanied by proteinuria, 84 were accompanied by hematuria, 37 were accompanied by varying degrees of edema and 21 were accompanied by hypertension. Among the extrarenal manifestations, 73 children had rash and 9 had lupus encephalopathy. There were 82 cases of leukopenia, 71 cases of anemia and 87 cases of thrombocytopenia. Compared with non-nephrotic syndrome (NS) group, the proportions of male, fever, hematuria, acute kidney injury, positive anti-double-stranded DNA antibody, and thrombocytopenia in NS group were higher, and the differences were statistically significant (P<0.05). Among the 98 children, the initial induction scheme was prednisone + cyclophosphamide in 61 cases, prednisone + mycophenolate mofetil in 22 cases, prednisone + tacrolimus in 8 cases, prednisone + azathioprine in 3 cases, and prednisone alone in 4 cases. Among the 96 children who underwent renal biopsy, the pathological classification was type Ⅱ in 4 cases, type Ⅲ in 9 cases, type Ⅳ in 45 cases, type Ⅴ in 8 cases, type Ⅳ + type Ⅴ in 25 cases, and type Ⅲ + type Ⅴ in 5 cases. From the onset of the disease to 6 months of treatment, 81 children (82.7%) had complete remission, 12 had partial remission, and 5 had no remission. Compared with the complete remission group, the proportion of irregular compliance in the non-complete remission group was higher, and the difference was statistically significant (P<0.05). A total of 92 patients were followed up, the median follow-up time was 5.2 (1.8-5.2) years, and 64 patients (69.6%) recurred. Compared with the non-recurrence group, the proportion of children with irregular compliance, >9 years old, complicated hypertension, complicated acute kidney injury and positive anti-double-stranded DNA antibody in the recurrence group was higher, and the difference was statistically significant (P<0.05). Conclusions The clinical manifestations of LN children are varied, and the curative effect is related to the compliance of the children. Recurrence was associated with age, compliance, combination of hypertension and acute kidney injury, and positive anti-double-stranded DNA antibody.

Key words: lupus nephritis, remission, prognosis, child