Impact of Clinical and Histopathological Features on Treatment Response and outcome in Pediatric Lupus Nephritis: Experience from Minia University Hospitals

Background: Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus (SLE), affecting up to 80% of children with the disease. It contributes significantly to long-term morbidity due to its potential progression to chronic kidney disease and end-stage renal failure. Aim: Evaluate the impact of clinical and histopathological features on treatment response and outcome in pediatric LN. Patient and method: A cross-sectional study was conducted on 60 children with biopsy-confirmed LN at Minia University Children’s Hospital between April 2024 and April 2025. Results: The median age was 14 years with female predominance (93.3%). The most frequent renal manifestations were proteinuria (90%) and edema (90%). Class III and IV LN were the most prevalent histopathological types (43.3% for each). All patients received steroids and hydroxychloroquine while 46% received mycophenolate mofetil (MMF) and 43% received cyclophosphamide treatment. Half of the patients achieved complete remission, while 40% were non-responsive and 10% had partial remission. MMF was associated with a significantly higher rate of complete remission compared to the cyclophosphamide group. A significant difference was noted between responder and non-responder groups regarding acute kidney injury and musculoskeletal manifestation (p = 0.038 and 0.018 respectively). Albumin/creatinine ratio was statistically significant predictor of activity in children with LN. Conclusion: These findings highlight the prognostic value of early histopathological classification and proteinuria severity in guiding treatment strategies for pediatric LN. Also, the study emphasizes the superiority of MMF over cyclophosphamide as an induction therapy and in terms of short-term treatment response.