Lupus Nephritis in Pediatric Practice: 20-Year Experience in Care

Purpose of the Study: assessment of the course and outcomes of the lupus nephritis in children; determination of the efficiency of use of the angiotensin-converting enzyme inhibitors for the lupus nephritis. Children Characteristics and Study Methods. Over a 20-year period, we analyzed the data of 36 children with the systemic lupus erythematosus and lupus nephritis at the ages from 5 to 17 years. Results. In 72.2% of the cases, the kidney damage was noted at the disease onset, and the severe, recurrent course of the lupus nephritis was registered. The nephrotic syndrome has developed in 47.2% of cases. All patients received the comprehensive treatment: corticosteroids, cyclophosphamide, azathioprine, selective immunosuppressants. A study was conducted for 23 children to determine the efficiency of the enalapril treatment prescribed for the purpose of the nephroprotection. It was revealed that this drug improves the long-term results. There was registered the twofold decrease in the disease recurrence rate, fivefold decrease in the level of daily proteinuria. Five-year survival rate was observed in 100% of the patients, 10-year – in 91.6%, end-stage renal failure was diagnosed in 8.4% of the children. 5 patients died in adult life (mortality rate is 13.9%). Conclusion. The children with the lupus nephritis require the continuation maintenance therapy. The use of the selective immunosuppressants and nephroprotectors has contributed to the renal survival