Development of clinical and laboratory biomarkers in an international cohort of 428 children with lupus nephritis

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Abstract Background There is no consensus on which treatment goals should be achieved to protect kidney function in children with lupus nephritis (LN). Methods We retrospectively analyzed trends of commonly used laboratory biomarkers of 428 patients (≤ 18 years old) with biopsy proven LN class ≥ III diagnosed and treated in the last 10 years in 25 international centers. We compared data of patients who developed stable kidney remission from 6 to 24 month with those who did not. Results Twenty five percent of patients maintained kidney stable remission while 75% did not. Significantly more patients with stable kidney remission showed normal hemoglobin and erythrocyte sedimentation rate values from 6 to 24 months compared to the group without stable kidney remission. Normal kidney function at onset, eGFR ≥90 ml/min/1.73m2, predicted the development of stable kidney remission (93.8%) compared to 64.7% in those without stable remission (P< 0.00001). At diagnosis 5.9% and 20.2% of the patients showed no proteinuria in the group with and without stable kidney remission respectively (P 0.0001). DsDNA antibodies decreased from onset of treatment mainly during the first 3 months in all the groups, but more than 50% of all patients in both groups never normalized after 6 months. Complement C3 and C4 increased mainly in the first three months in all the patients without any significant difference. Conclusion Normal eGFR and the absence of proteinuria at onset and the normalization of Hb and ESR from 6 to 24 month were predictors of stable kidney remission.