Lupus Nephritis in Children: An Experience in Tertiary Care Centres

Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus in children, and is a leading cause of long-term morbidity. However, local data on paediatric LN from Sri Lanka are limited. This study aimed to describe the clinicopathological characteristics, management strategies, treatment outcomes and complications of childhood LN across three tertiary care centres in Sri Lanka.
A retrospective descriptive study was conducted among children less than 16 years with biopsy-proven LN. Demographic, clinical, biochemical, histological and therapeutic data were extracted from medical records. Disease activity and chronicity indices were assessed using NIH criteria. The time taken to reach remission was analysed using the Kaplan–Meier method, and predictors of remission were evaluated using Cox proportional hazards modelling.
Thirty eight children (mean age 11.8 ± 2.6 years, 68.4% female) were included. Majority presented with proteinuria and proliferative LN was predominant (class IV: 55%; class III: 26%). Hyaline necrosis and cellular crescents were significantly associated with higher activity scores. Patients treated with cyclophosphamide (CYC) achieved remission faster than those who did not receive it (p = 0.024). Male sex (HR = 2.90, p = 0.030), a higher activity index (HR = 0.88, p = 0.034) and proliferative class (HR = 0.04, p = 0.001) were associated with delayed remission. Five patients experienced relapse during follow-up, with higher chronicity indices and more frequent tubulointerstitial damage. No deaths were recorded.
Childhood LN in Sri Lanka predominantly presented as a proliferative disease with moderate activity and low chronicity. Cyclophosphamide induction therapy was found to achieve earlier remission, while male sex, higher activity and proliferative class were found to predict a delayed remission. Although relapses occurred in a minority, the overall outcomes were favourable.