Objective: To deeply understand prognosis of pediatric cases with lupus nephritis (LN) treated in our hospital and analyze the prognostic factors.
Method: One hundred and one patients were enrolled, who were diagnosed as lupus nephritis in our hospital during the period from Jan. 1996 to Dec. 2007. Clinical data were retrospectively analyzed; the observation was ended on 31(st) Dec. 2009. Patients were divided into renal biopsy group and non renal biopsy group; group A (type I + II LN), group B (type III + IV LN) and group C (type V LN); CTX group (cyclophosphamide) and MMF group (mycophenolate mofetil); remission group (complete remission and partial remission) and ineffective group (treatment failure and death). Medication non-compliance means (1) the interval of CTX pulse was more than 45 days or treatment course less than 6 times; (2) patients discontinued MMF or other immunosuppressant on themselves more than a week ago. SPSS 11.0 software Life-Tables method was used to analyze cumulative survival rates.
Result: (1) Three and five years' patient survival rates were 93.59% and 87.80% respectively. Three and five years' kidney survival rates were 100% and 91.12% respectively. (2) Univariate analysis showed that induction remission were related to five factors, including whether received renal biopsy (χ(2) = 9.023, P = 0.003), different pathological types (χ(2) = 9.437, P = 0.009), different induction drug (χ(2) = 4.610, P = 0.032), treatment compliance (χ(2) = 18.716, P = 0.000) and proteinuria amount (χ(2) = 8.013, P = 0.046), and maintenance remission were related to the former four factors (χ(2) = 10.209, P = 0.001;χ(2) = 7.757, P = 0.021;χ(2) = 4.206, P = 0.04;χ(2) = 24.571, P = 0.000). (3) Multivariate analysis showed that maintenance remission was mainly related to medication-compliance (χ(2) = 9.818, P = 0.002). Poor medication compliance mainly occurred in non renal biopsy group (χ(2) = 9.569, P = 0.002). (4) In renal biopsy group, 15 cases showed a small amount proteinuria, 4 of them were proved as severe pathological type LN (2 cases type III, 1 case type IV and 1 case type V). (5) In group B, no medication non-compliance occurred, and the efficacy of MMF and CTX had no significant difference (P = 0.405).
Conclusion: The main affecting factor of remission rate was medication compliance. In type III and IV lupus nephritis, the efficacy of MMF and CTX were no significant difference. The poor outcome of non-renal biopsy group may be due to unclear pathological classification and poor medication compliance. We strongly recommend that SLE patients with mild abnormal results of urinalysis should receive renal biopsy.