Clinical Presentation and Biochemical Parameters of Childhood Lupus Nephritis and Its Correlation with Underlying Renal Histopathology: A Cross-sectional Study

Open Access

Abstract

Background: Lupus nephritis is a major concern in patients with systemic lupus erythematosus. Clinical presentation and biochemical parameters are usually correlated with histopathological classes of lupus nephritis; however, patients with mild clinical features may have moderate to severe glomerular injury, while severe presentations may sometimes show less severe damage. The aim of this study was to assess clinical presentation and biochemical parameters of childhood lupus nephritis and their correlation with renal histopathology. Methods & Materials: This cross-sectional observational study was conducted in the Department of Pediatric Nephrology, Bangladesh Shishu Hospital & Institute (BSH&I), from October 2022 to March 2024. A total of 44 children aged 4-18 years who fulfilled the 2019 ACR/EULAR criteria. Results: Among 44 participants, mean age was 10.6 years with a female-to-male ratio of 3.4:1. About 81.81% had nephritis with systemic features and 18.19% had isolated lupus nephritis. Class IV was the most common histopathological class (32%). Proteinuria was present in 97.3%, of whom 56.8% had nephrotic-range proteinuria. Other findings included hematuria, anasarca, hypertension, and acute kidney failure. Anasarca, nephrotic-range proteinuria, acute kidney failure, reduced eGFR, increased spot uPCR, hypoalbuminemia, SLEDAI, and renal SLEDAI were significantly higher in Class IV LN. However, 18.18% of Class II LN also had nephrotic-range proteinuria. Non-nephrotic proteinuria was significantly higher in Class II LN (p=0.005), but was also seen in 22.22% of Class III, 14.28% of Class IV, and 33.33% of Class V LN. Conclusion: Clinical and biochemical severity is greater in advanced lupus nephritis, especially Class IV LN.