Renal Outcomes in 1528 Childhood-onset Systemic Lupus Erythematosus Patients: A Brazilian Multicenter Study

Ana Paula Sakamoto¹, Clovis Silva², Aline Islabão³, Glaucia Novak², Beatriz Molinari², Rosa Pereira⁴, Claudia Saad-Magalhães⁵, Gleice Clemente⁶, Daniela Petry Pioto⁷, Nadia Aikawa⁴, Ana Pita², Vitor Trindade², Simone Appenzeller⁸, Luciana Carvalho⁹, Carlos Rabelo-Junior¹⁰, Adriana Fonseca¹¹, Flavio Sztajnbok¹², Maria Santos¹³, Blanca Elena Rios Gomes Bica¹⁴, Evaldo Sena¹⁵, Ana Moraes¹⁶, Melissa Fraga⁶, Teresa Robazzi¹⁷, Paulo Spelling¹⁸, Iloite Scheibel¹⁹, Andre Cavalcanti²⁰, Erica Matos²¹, Luciano Guimarães²², Flavia Santos²³, Licia Maria Henrique Mota²⁴, Eloisa Bonfá⁴ and Maria Terreri²⁵, ¹Federal University of So Paulo (UNIFESP), São Paulo, Brazil, ²Pediatric Rheumatology Unit, Children’s Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, ³Pediatric Rheumatology Unit, Hospital da Criança de Brasília Jose Alencar, Brasilia, DF, Brazil, ⁴Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ⁵Pediatric Rheumatology Division, São Paulo State University (UNESP) – Faculdade de Medicina de Botucatu, Botucatu, Botucatu, Brazil, ⁶Universidade Federal de São Paulo, São Paulo, Brazil, ⁷Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil, ⁸Hospital das Clínicas da Universidade Estadual de Campinas, Campinas, Brazil, ⁹Pediatric Rheumatology Unit, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil, ¹⁰Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil, ¹¹Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, RJ, Brazil, ¹²UFRJ/UERJ, Rio de Janeiro, Brazil, ¹³Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil, ¹⁴Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, ¹⁵Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, PB, Brazil, ¹⁶Pediatric Rheumatology Unit, Federal University of Pará, Belém, PA, Brazil, ¹⁷Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, BA, Brazil, ¹⁸Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, PR, Brazil, ¹⁹Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, RS, Brazil, ²⁰Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, PE, Brazil, ²¹Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil, ²²Pediatric Rheumatology Unit, University of Brasília, Brasilia, DF, Brazil, ²³Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Belo Horizonte, MG, Brazil, ²⁴Universidade de Brasília, Brasilia, Brazil, ²⁵UNIFESP, São Paulo, Brazil

Meeting: ACR Convergence 2021

Keywords: Adolescent, Childhood-onset systemic lupus erythematosus, end-stage renal disease, Lupus nephritis, Pediatric rheumatology

Session Information

Date: Sunday, November 7, 2021

Title: Pediatric Rheumatology – Clinical Poster II: SLE, JDM, & Juvenile Scleroderma (0764–0785)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: Lupus nephritis is a frequent manifestation in childhood-onset systemic lupus erythematosus (cSLE) and has a great potential for chronic kidney disease (CKD), requiring dialysis and kidney transplantation, with great loss in health-related quality of life. The objective of this study was to analyze renal outcomes and CKD in cSLE and to assess its association with cumulative clinical and laboratory features, current disease activity and damage, cumulative treatments, and outcomes.

Methods: This is a multicenter, nationwide observational study of a cohort of 1,528 cSLE patients followed in 27 Brazilian pediatric rheumatology tertiary centers. All patients fulfilled the American College of Rheumatology (ACR) 1997 criteria for classification of SLE, with disease onset before 18 years of age. In this study, we investigated cumulative risk factors for KF in a large sample of cSLE patients.

Results: A total of 59/1528 (3.9%) of patients presented CKD. After Bonferroni´s correction for multiple comparisons (p˂0.0013), determinants significantly associated with CKD were urinary sediment alterations, neuropsychiatric involvement, higher scores of current SLEDAI-2K and SLICC/ACR-DI (especially renal involvement), as well as cumulative use of intravenous methylprednisolone, cyclophosphamide, and rituximab. In regression models, arterial hypertension (HR=15.42, 95%CI=6.12-38.83, p≤0.0001) and biopsy-proven proliferative nephritis (HR=2.83, 95%CI=1.70-4.72, p≤0.0001) increased the risk of CKD. The Kaplan-Meier overall curves showed significantly worse patient survival in cSLE patients with biopsy-proven proliferative nephritis (p=0.02) and CKD (p≤0.0001).

Conclusion: This study showed that cSLE patients with arterial hypertension and biopsy-proven proliferative nephritis exhibited higher hazard rates of progression to poor outcomes. Therefore, those patients could benefit from strict blood pressure control during follow-up, and better drug treatment for aggressive management of active lupus nephritis.

Disclosures: A. Sakamoto, None; C. Silva, None; A. Islabão, None; G. Novak, None; B. Molinari, None; R. Pereira, None; C. Saad-Magalhães, None; G. Clemente, None; D. Pioto, None; N. Aikawa, None; A. Pita, None; V. Trindade, None; S. Appenzeller, None; L. Carvalho, None; C. Rabelo-Junior, None; A. Fonseca, None; F. Sztajnbok, Novartis, 1, 6, Alexion, 6; M. Santos, None; B. Elena Rios Gomes Bica, None; E. Sena, None; A. Moraes, None; M. Fraga, None; T. Robazzi, None; P. Spelling, None; I. Scheibel, None; A. Cavalcanti, None; E. Matos, None; L. Guimarães, None; F. Santos, None; L. Mota, Janssen, 1, 6, Pfizer, 6, UCB, 6, Abbvie, 6, Boehringer Ingelheim, 6, Sandoz, 6, Amgen, 6, GSK, 1, Lilly, 6; E. Bonfá, None; M. Terreri, Sanofi, 6, Alexion, 6, Pfizer, 6, Novartis, 6, Abbvie, 6, Roche, 6, Biomarin, 6, GSK, 6, Jansen, 12, Clinical studies, UCB, 12, Clinical studies, Bristol, 12, Clinical studies, Lilly, 12, Clinical studies.

To cite this abstract in AMA style:

Sakamoto A, Silva C, Islabão A, Novak G, Molinari B, Pereira R, Saad-Magalhães C, Clemente G, Pioto D, Aikawa N, Pita A, Trindade V, Appenzeller S, Carvalho L, Rabelo-Junior C, Fonseca A, Sztajnbok F, Santos M, Elena Rios Gomes Bica B, Sena E, Moraes A, Fraga M, Robazzi T, Spelling P, Scheibel I, Cavalcanti A, Matos E, Guimarães L, Santos F, Mota L, Bonfá E, Terreri M. Renal Outcomes in 1528 Childhood-onset Systemic Lupus Erythematosus Patients: A Brazilian Multicenter Study [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/renal-outcomes-in-1528-childhood-onset-systemic-lupus-erythematosus-patients-a-brazilian-multicenter-study/. Accessed .

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/renal-outcomes-in-1528-childhood-onset-systemic-lupus-erythematosus-patients-a-brazilian-multicenter-study/