A RETROSPECTIVE STUDY ON LUPUS NEPHRITIS: EXAMINING CLINICAL, SEROLOGICAL, AND PROGNOSTIC DIFFERENCES BETWEEN PEDIATRIC AND ADULT-ONSET PATIENTS IN A TERTIARY MEDICAL CENTER

PT008 / #89 Topic: AS15 - Lupus Nephritis-Clinical POSTER TOUR 02: RECENT INSIGHTS ON THE PATHOGENESIS OF LUPUS NEPHRITIS 23-05-2025 10:00 AM - 10:40 AM Background/Purpose Renal involvement occurs in about 40-50% of adult SLE patients. Pediatric-onset SLE nephritis is more common and severe than in adults. This study evaluates the differences in renal involvement and clinical outcomes between childhood-onset and adult-onset SLE. Methods This retrospective study at a rheumatology center included 177 biopsy-proven nephritis cases. Demographic, clinical, and lab data were collected. Renal pathology was assessed using the 2018 ISN/RPS criteria, comparing various pathological features and thrombotic microangiopathy between adult and pediatric SLE nephritis. Pre-2018 biopsies were re-evaluated by an experienced pathologist. Treatment protocols and therapeutic goals were compared, and correlations between clinicopathologic parameters and chronic kidney disease were analyzed. Results In this study, 168 biopsy-proven nephritis cases (128 adults, 40 children) were analyzed. The female-to-male ratio was similar in both groups (Table 1). The median time from SLE diagnosis to biopsy was shorter in children than adults. ISN/RPS Class IV was the most common pathology in both groups. Chronicity scores were higher in adults, while activity scores were similar. Rituximab was more commonly used in adults, but cyclophosphamide and mycophenolate mofetil usage did not differ. More children achieved prednisolone-free status with low proteinuria compared to adults. End-stage renal failure was more frequent in adults. Regression analysis showed a negative correlation between CKD and childhood-onset lupus nephritis, with fibrinoid necrosis negatively correlated and endocapillary hypercellularity and glomerular sclerosis positively correlated with CKD (Table 2). APL positivity was higher in adults but not linked to CKD. Table 1. Comparison of Demographic, Laboratory, and Clinical Modalities in Adult-Onset versus Childhood-Onset Systemic Lupus Erythematosus Patients. Table 2. Significant Parameters Identified in Correlation Analysis for Chronic Kidney Disease. Conclusions As opposed to current literature, our study reveals that childhood-onset lupus nephritis has a lower likelihood of progressing to end-stage renal disease with a more favorable treatment response, while the clinical manifestations are not different from adult-onset SLE nephritis. Additionally, endocapillary hypercellularity and glomerular sclerosis are slightly correlated with CKD, while the presence of fibrinoid necrosis is negatively correlated with CKD.