Pereira M, et al. - This single-center cohort study of consecutively diagnosed children with pure membranous lupus nephritis (MLN) assessed the clinical presentation and outcomes in these patients. Favorable outcomes were observed in this cohort of childhood-onset MLN. Researchers also utilized pediatric renal outcomes definitions and found that response rates, as well as rates of renal flare, were high.

Methods

• Researchers conducted a single-center cohort study of consecutively diagnosed children with pure MLN from 1990 and 2016.
• Patients received care in Houston, Texas, one of the most diverse metropolitan areas in North America.
• They used consensus definitions from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) in order to obtain renal outcomes.
• They also used logistic regression to detect predictors of complete renal response.

Results

• Researchers identified a total of 56 children with MLN (82% females, 44% black, 35% Hispanic) with a median follow-up time of 4.1 years.
• The documented mean age of MLN onset was 13.7 ± 3.4 years.
• Nephrotic syndrome and acute kidney injury were detected in 69% and 11%, respectively, on initial presentation.
• Glucocorticoids and anti-malarials were prescribed in 96% and 88% of patients, respectively.
• The most common non-steroid immunosuppressive agent (69%) was mycophenolate mofetil, followed by rituximab (25%), cyclophosphamide (18%), and azathioprine (9%).
• 78% of patients were prescribed renin–angiotensin aldosterone system blocking agents .
• Findings demonstrated that out of 37 patients with ≥2 years of follow-up, 74% achieved complete renal response at 24 months.
• In addition, researchers found no predictor variable of complete renal response in this small cohort.
• Occurrence of renal flares was reported in 48% of patients (86% proteinuric, 14% nephritic), .
• It was also noted that subsequent renal biopsy demonstrated proliferative nephritis in 13% patients.