Lupus Nephritis in Indian Children: Flares and Refractory Illness.

OBJECTIVE: To evaluate the incidence of flares and treatment resistance in children with lupus nephritis and their association with renal outcomes.

METHODS: We retrospectively reviewed the case records of 34 children treated for lupus nephritis (Class II-IV) at a single center. Patients were followed for a minimum of five years to evaluate treatment response, onset of flares, and renal survival. Regression analyses were performed to identify the factors associated with treatment refractoriness, incidence of flares and renal survival.

RESULTS: The incidence of flares was 0.16 episodes/person/year. Eight patients (23.5%) were refractory to treatment. The five-year renal survival was 79%. Multiple episodes of flares (P=0.028) and therapy refractoriness (P=0.003) were associated with poor renal survival.

CONCLUSIONS: Prevention and aggressive management of renal flares is expected to prevent progression to end stage renal disease in lupus nephritis.