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.
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 December 4, 2021.« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-follow-up-of-inner-city-pediatric-patients-with-lupus-nephritis/