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Abstract Number: 406

Long Term Follow up of Inner City Pediatric Patients with Lupus Nephritis

Janice Desir1, Beatrice Goilav2, Ellen Silver3 and Irene Blanco4, 1Pediatric Nephrology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, 2Division of Nephrology, Children's Hospital at Montefiore, Bronx, NY, 3Pediatrics, Albert Einstein College of Medicine, Bronx, NY, 4Medicine, Albert Einstein College of Medicine, Bronx, NY

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: health disparities, lupus nephritis and pediatric rheumatology

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Session Information

Date: Sunday, November 8, 2015

Session Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster I: Lupus, Scleroderma, JDMS

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

In children with SLE, 80% have renal involvement, which is a major prognostic factor for both morbidity and mortality. Few studies have focused on long-term outcomes of this underserved population, who are at increased risk for high disease severity. This project evaluates high risk children with biopsy confirmed lupus nephritis (LN) to assess clinical and demographic factors that may be related to ESRD and/or death.

Methods:

We conducted a retrospective chart review of patients with LN from 1997-2011 at the Children’s Hospital at Montefiore. Patients were less than 20 years old at time of biopsy and followed up to 5 years post biopsy or onset of renal failure/death. We compared nonESRD patients (NonE) to those with ESRD and/or death (ESRD) at baseline and looked at: creatinine, pyuria, hematuria, renal histology, protein to creatinine ratio (uP/C), albumin, hemoglobin, age, gender, race, insurance and medications.

Results:

A total of 36 patients were evaluated. 86% lived in the Bronx and more than 60% were from low-income/high poverty areas. The mean age was 14.4 + 2.5 years and 69.4% were female. 92.0% were African American, Hispanic or multiracial. Histology revealed 14% Mesangial LN (Class II,5/36), 56% Proliferative LN (Class III or Class IV, 20/36) 31% Membranous LN (Class V, 11/36).  61% were Medicaid insured (n=22) vs 39% privately insured (n=14).  In the ESRD group 100% (n=9) were Medicaid vs 48% (n=13/27) in the NonE.

Development of ESRD was not associated with creatinine, pyuria, hematuria, histology, uP/C, albumin, hemoglobin, age, gender, race and medications at the time of biopsy. However, having private insurance was significantly protective where 100% of those with Medicaid developed ESRD  (P = 0.006).

Conclusion:

In our cohort, 25% of children went on to develop ESRD. The only factor that was significant for this was being Medicaid insured. This suggests the type of access to healthcare and associated non-genetic factors may play a role in progressive disease among this group.


Disclosure: J. Desir, None; B. Goilav, None; E. Silver, None; I. Blanco, None.

To cite this abstract in AMA style:

Desir J, Goilav B, Silver E, Blanco I. Long Term Follow up of Inner City Pediatric Patients with Lupus Nephritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/long-term-follow-up-of-inner-city-pediatric-patients-with-lupus-nephritis/. Accessed June 1, 2023.
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