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. Pediatr Nephrol 2023 May;38(5):1653-1665
Date
10/18/2022Pubmed ID
36251074DOI
10.1007/s00467-022-05775-zScopus ID
2-s2.0-85139953316 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
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.
Author List
Stotter BR, Cody E, Gu H, Daga A, Greenbaum LA, Duong MD, Mazo A, Goilav B, Boneparth A, Kallash M, Zeid A, Seeherunvong W, Scobell RR, Alhamoud I, Carter CE, Shah S, Straatmann CE, Dixon BP, Cooper JC, Nelson RD, Levy DM, Brunner HI, Verghese PS, Wenderfer SEAuthor
Ellen Cody MD Assistant Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute Kidney InjuryAdolescent
Adult
Arthritis, Juvenile
Atrophy
Child
Cohort Studies
Female
Fibrosis
Humans
Lupus Nephritis
Male
Nephrology
Renal Dialysis
Retrospective Studies
Rheumatology
