Childhood lupus nephritis : 12 years experience from North India

Twenty-five children (20 girls and five boys) with lupus nephritis seen over last 12 years, were evaluated. Twenty underwent renal biopsies. Cyclophosphamide pulse therapy was used in eight patients (median 14 pulses, range 6-16) with severe disease or histological class. Four of these eight patients became asymptomatic (class IV, 2; class II and V, one each) after 4-24 months. Two (class III and IV, one each) died after a stable chronic renal insufficiency for almost a decade; one died 9 months after diagnosis (class IV). Of the 12 patients who underwent biopsy but were not treated with cyclophosphamide, six became asymptomatic during follow up (class II, four patients; class VI and V, one each), two continued to have proteinuria (class II), one (class IV) had raised ESR but normal renal functions and two died (class IV). Three of the five patients who were not biopsied remained asymptomatic; two were lost to follow up. Mortality was seen only with class III (one patient) or class IV (five patients) lesions. Outcome in lupus nephritis depends largely on WHO histological class. Cyclophosphamide pulse therapy is associated with a favorable outcome.