Brian R Stotter1, Ellen Cody2, Hongjie Gu3, Ankana Daga4, Larry A Greenbaum5, Minh Dien Duong6, Alexandra Mazo6, Beatrice Goilav6, Alexis Boneparth7, Mahmoud Kallash8, Ahmed Zeid8, Wacharee Seeherunvong9, Rebecca R Scobell10, Issa Alhamoud11, Caitlin E Carter12, Siddharth Shah13, Caroline E Straatmann14, Bradley P Dixon15, Jennifer C Cooper15, Raoul D Nelson16, Deborah M Levy17, Hermine I Brunner2,18, Priya S Verghese19, Scott E Wenderfer20. 1. Division of Pediatric Nephrology, Hypertension, and Pheresis, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA. bstotter@wustl.edu. 2. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 3. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA. 4. Division of Nephrology, Boston Children's Hospital, Boston, MA, USA. 5. Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA. 6. Division of Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA. 7. Columbia University Irving Medical Center, New York, NY, USA. 8. Division of Nephrology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA. 9. University of Miami Miller School of Medicine, Miami, FL, USA. 10. Children's Hospital of Philadelphia, Philadelphia, PA, USA. 11. University of Iowa Stead Family Children's Hospital, Carver College of Medicine, Iowa City, IA, USA. 12. Department of Pediatrics, Division of Pediatric Nephrology, University of California and Rady Children's Hospital, San Diego, CA, USA. 13. Department of Pediatric Nephrology, Norton Children's Hospital and the University of Louisville, Louisville, KY, USA. 14. LSU Health and Children's Hospital, New Orleans, LA, USA. 15. Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA. 16. Division of Pediatric Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA. 17. The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 18. Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA. 19. Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 20. Division of Pediatric Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.
Abstract
BACKGROUND: Acute kidney injury (AKI) is common in lupus nephritis (LN) and a risk factor for development of chronic kidney disease. In adults with LN, AKI severity correlates with the incidence of kidney failure and patient survival. Data on AKI outcomes in children with LN, particularly those requiring kidney replacement therapy (KRT), are limited. METHODS: A multicenter, retrospective cohort study was performed in children diagnosed between 2010 and 2019 with LN and AKI stage 3 treated with dialysis (AKI stage 3D). Descriptive statistics were used to characterize demographics, clinical data, and kidney biopsy findings; treatment data for LN were not included. Logistic regression was used to examine the association of these variables with kidney failure. RESULTS: Fifty-nine patients (mean age 14.3 years, 84.7% female) were identified. The most common KRT indications were fluid overload (86.4%) and elevated blood urea nitrogen/creatinine (74.6%). Mean follow-up duration was 3.9 ± 2.9 years. AKI recovery without progression to kidney failure occurred in 37.3% of patients. AKI recovery with later progression to kidney failure occurred in 25.4% of patients, and there was no kidney recovery from AKI in 35.6% of patients. Older age, severe (> 50%) tubular atrophy and interstitial fibrosis, and National Institutes of Health (NIH) chronicity index score > 4 on kidney biopsy were associated with kidney failure. CONCLUSIONS: Children with LN and AKI stage 3D have a high long-term risk of kidney failure. Severe tubular atrophy and interstitial fibrosis at the time of AKI, but not AKI duration, are predictive of kidney disease progression. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Acute kidney injury (AKI) is common in lupus nephritis (LN) and a risk factor for development of chronic kidney disease. In adults with LN, AKI severity correlates with the incidence of kidney failure and patient survival. Data on AKI outcomes in children with LN, particularly those requiring kidney replacement therapy (KRT), are limited. METHODS: A multicenter, retrospective cohort study was performed in children diagnosed between 2010 and 2019 with LN and AKI stage 3 treated with dialysis (AKI stage 3D). Descriptive statistics were used to characterize demographics, clinical data, and kidney biopsy findings; treatment data for LN were not included. Logistic regression was used to examine the association of these variables with kidney failure. RESULTS: Fifty-nine patients (mean age 14.3 years, 84.7% female) were identified. The most common KRT indications were fluid overload (86.4%) and elevated blood urea nitrogen/creatinine (74.6%). Mean follow-up duration was 3.9 ± 2.9 years. AKI recovery without progression to kidney failure occurred in 37.3% of patients. AKI recovery with later progression to kidney failure occurred in 25.4% of patients, and there was no kidney recovery from AKI in 35.6% of patients. Older age, severe (> 50%) tubular atrophy and interstitial fibrosis, and National Institutes of Health (NIH) chronicity index score > 4 on kidney biopsy were associated with kidney failure. CONCLUSIONS: Children with LN and AKI stage 3D have a high long-term risk of kidney failure. Severe tubular atrophy and interstitial fibrosis at the time of AKI, but not AKI duration, are predictive of kidney disease progression. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Linda T Hiraki; Bing Lu; Steven R Alexander; Tamara Shaykevich; Graciela S Alarcón; Daniel H Solomon; Wolfgang C Winkelmayer; Karen H Costenbader Journal: Arthritis Rheum Date: 2011-07
Authors: Scott E Wenderfer; Joyce C Chang; Amy Goodwin Davies; Ingrid Y Luna; Rebecca Scobell; Cora Sears; Bliss Magella; Mark Mitsnefes; Brian R Stotter; Vikas R Dharnidharka; Katherine D Nowicki; Bradley P Dixon; Megan Kelton; Joseph T Flynn; Caroline Gluck; Mahmoud Kallash; William E Smoyer; Andrea Knight; Sangeeta Sule; Hanieh Razzaghi; L Charles Bailey; Susan L Furth; Christopher B Forrest; Michelle R Denburg; Meredith A Atkinson Journal: Clin J Am Soc Nephrol Date: 2021-11-03 Impact factor: 8.237