Abstract
Objective
To determine the long-term outcome of Maori and Pacific Island children diagnosed with childhood onset lupus nephritis.
Method
A chart review was conducted of children diagnosed with biopsy proven lupus nephritis seen by the Starship Hospital and Kidz First paediatric rheumatology and/or Starship renal services between January 1992 and January 2018. Baseline and follow-up kidney histology, adherence and response to therapy including partial or full renal remission, refractory disease, end-stage kidney disease (ESKD) and mortality were determined.
Results
In a New Zealand cohort of 42 with childhood onset lupus nephritis, Maori and Pacific Island children were significantly more likely to develop class 4 lupus nephritis (RR (95% CI), 11.3 (3.84–49.9), p < 0.0001), demonstrate medication nonadherence (RR (95% CI) 12.4 (3.48–85.7), p < 0.0001) and experience end stage kidney disease (RR (95% CI) 15.7 (2.97–389.3), p = 0.0003) and mortality (RR (95% CI) 11.1 (1.91–280.1), p = 0.005) compared to non-Maori and Pacific Island children. In addition, Maori children with childhood onset lupus nephritis developed chronic histological changes significantly more rapidly than Pacific or Asian children (p = 0.038).
Conclusion
Lupus nephritis is more common among Maori and Pacific Island children in New Zealand associated with a significant incidence of end stage kidney disease and mortality, with some Maori children developing rapid histologic disease progression.
Get full access to this article
View all access options for this article.