Year: 2025
Type: article
Study design: Observational Study
Abstract: BackgroundThe aim of this study was to evaluate the relationship between modified Primary Efficacy Renal Response (mPERR) and modified Complete Renal Response (mCRR) at 24-months postbiopsy and long-term kidney outcomes in childhood-onset lupus nephritis (cLN). MethodWe conducted a cohort study of biopsy-proven cLN diagnosed <18 years of age between 2001 to 2023, with prospective data collected from 2021 to 2025.We examined the relationship between modified versions of PERR (mPERR) and CRR (mCRR) at 24-months post-biopsy and survival free from advanced chronic kidney disease, including kidney failure (CKD 4-5D/T). ResultsOne-hundred-and-seven Chinese children (93 female; median age at diagnosis, 13.7 years, IQR 11.0-16.6)were analysed.Ninety-seven (91%) had proliferative LN.The median observation period was 12.0 years (IQR, 6.4-17.8).At 24-months post-biopsy, 93 (87%) and 81 (76%) subjects were mPERR and mCRR responders, respectively.Kaplan-Meier analysis showed mPERR responders at 24-months had superior CKD 4-5D/T free survival (responders: 100%, 98.8% and 97.2%; non-responders 92.9%, 78.6% and 78.6% at 1-, 5-and 10-years following 24-months post-biopsy; log-rank p=0.013).Achieving mCRR trended towards better kidney survival.Multivariable analysis identified 24-months mPERR non-response (HR adj 4.39, 95% CI 1.04-18.4,p=0.04) and baseline eGFR <60ml/min/1.73m 2 (HR adj 6.07, 95% CI 1.21-30.39,p=0.03) as predictors of CKD 4-5D/T.Forty-four subjects (41%) experienced 89 kidney relapse episodes.Kaplan-Meier analysis showed that non-response by mPERR (log-rank p<0.001) and mCRR (log-rank p=0.03) at 24months were associated with inferior relapse-free survival.Conclusion mPERR at 24-months predicts long-term kidney survival in cLN.Achieving mPERR and mCRR shows significant benefits on lower risk of renal relapse. J o u r n a l P r e -p r o o f
Source: Kidney International Reports
Authors: Eugene Yu-hin Chan, Kevin Chun-hei Wu, Dongyang Zhou, Kyle Ying-kit Lin, Justin Ming-yin Ma, Sze-wa Wong, Fiona Fung-yee Lai, Tsz-wai Ho, Pak-chiu Tong, Wai-ming Lai, Desmond Yat-hin Yap, Tak Mao Chan, Alison Lap-tak Ma
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,800
OpenAlex ID: W4416713310