Varied Kidney Outcomes of Pediatric Lupus Nephritis Patients: A Retrospective Cohort Study Pubblico

Abstract

Background: Lupus nephritis (LN), the renal manifestation of systemic lupus erythematosus (SLE), carries significant morbidity and mortality. Early diagnosis and treatment are critical to prevent progressive kidney damage and improve long-term prognosis. There is evidence suggesting disparities in treatment response across different patient populations. This study investigates the association between race/ethnicity and remission status in pediatric LN patients.

Methods: This retrospective cohort study included 101 pediatric LN patients at Children's Healthcare of Atlanta (CHOA) with biopsy-proven LN diagnosed between 2010 and 2022. Patients were followed for at least 1 year after LN diagnosis. Associations between race/ethnicity and renal outcomes (complete remission, partial remission) were assessed using Kaplan-Meier curves, Cox proportional hazards, and accelerated failure time models. 

Results: The study population was primarily non-Hispanic Black (52.5%) and female with a median age of 14.0 years at LN diagnosis. For adjusted models of complete remission, patients in the non-Hispanic White and Other subgroups were found to have statistically significantly greater likelihoods to achieve remission at 12 months after LN diagnosis and accelerated time to remission at 24 months after LN diagnosis. For adjusted models of partial remission, The Other subgroup was found to have a statistically significant greater likelihood to achieve remission at 12 months after LN diagnosis and accelerated time to remission at 24 months after LN diagnosis. The crude models for both complete and partial remission were insignificant for race/ethnicity alone. 

Conclusion: Race/ethnicity, when adjusted by other variables, is statistically associated with short-term remission status, generally with Hispanic and non-Hispanic Blacks being less likely to achieve both complete and partial remission. Future studies should elucidate the role of social determinants of health on clinical outcomes and further analyze other predictors affecting renal survival within the pediatric LN population.

Table of Contents

Introduction.....................................................................1

Systemic Lupus Erythematosus (SLE).................................1

Lupus Nephritis (LN).........................................................2

Lupus Nephritis Epidemiology............................................4

Treatment of Lupus Nephritis.............................................4

Why Children?.................................................................10

Study Question................................................................12

Study Aims.......................................................................12

Hypothesis......................................................................13

Patients and Methods.......................................................13

Study Population..............................................................13

Measurements.................................................................14

Treatment Courses...........................................................15

Statistical Methods...........................................................15

Operational Definitions....................................................19

Lupus Nephritis...............................................................19

Renal Biopsy and Histology...............................................20

Kidney Function...............................................................20

Induction and Maintenance Drug Dosage...........................21

Renal Response................................................................21

Lupus Nephritis Flare/Relapse...........................................21

End Stage Renal Disease & Renal Replacement Therapy......22

Results.............................................................................23

Study Population Characteristics.......................................23

Race/Ethnicity on Remission Status...................................23

LN Class on Remission Status............................................25

Treatment Course on Remission Status..............................26

LN Flares.........................................................................27

Discussion.......................................................................28

References.......................................................................34

Abbreviations...................................................................40

Tables and Figures............................................................42

About this Honors Thesis

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School	Emory College
Department	Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, General
Parola chiave	Retrospective Chart Review Pediatric Lupus Nephritis
Committee Chair / Thesis Advisor	Amirtha Chinnadurai, Emory University
Committee Members	Jada Hoyle-Gardner, Emory University Megan Cole, Emory University

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