Epidemiology and prognosis of childhood lupus nephritis in the Afro-descendant population of the French Overseas Departments of America.

INTRODUCTION

Lupus nephritis (LN) is a severe manifestation of pediatric systemic lupus erythematosus (pSLE). This study aims to describe the epidemiology, clinical, biological, histological features and prognosis of pediatric LN in the Afro-descendant (AD) population of the French Overseas Departments of America.

METHODS

We conducted a retrospective and longitudinal multicenter study of pediatric LN patients from January 2000 to June 2024. Patients were identified from multiple sources including pediatricians' registries, pathologist's registries for kidney biopsies, national registry for rare diseases and referral centers. Data were collected from medical records. Diagnostic criteria for pSLE kidney impairment were based on international classifications.

RESULTS

Twenty-seven patients with pediatric LN were included. The mean age at diagnosis was 11.3 years (range: 6-17) and mean follow-up duration was 7.5 years (range: 0.3-27). Kidney involvement (75% of ISN/RPS class III/IV) was present at pSLE diagnosis in 55% of patients. Kidney flares occurred more frequently in patients under 12 years of age at diagnosis, with an average of 1.7 flares per patient (p = 0.03). The mean number of background therapy per patient during follow up was 2.5 (1-5) with a majority (n = 15, 55%) receiving glucocorticoids and mycophenolate mofetil as first line. Six patients (22%) had an eGFR below 60 ml/min/1.73m2 at the last follow-up (2 patients on dialysis, 2 had kidney transplants).

CONCLUSION

This study represents the largest cohort of pediatric LN in AD population. Younger patients exhibited more frequent kidney flares, particularly within the first two years of diagnosis. Overall outcomes in pediatric LN showed a higher rate of dialysis and kidney failure than in Caucasian series.

CLINICAL TRIAL NUMBER: Not applicable.