Abstract
Background: Lupus nephritis (LN) badly affects the outcome in adolescents and young adults with sys- temic lupus erythematosus (SLE). Many have renal disease at onset and the significance of remission and relapse in adolescents and young adults is poorly evaluated. Aim of work: To outline the clinical and laboratory characteristics of treatment resistance, renal relapse and progression to end -stage renal disease (ESRD) in adolescents and young adults with LN. Patients and methods: Eighty-five biopsy -proven LN patients were examined; SLE disease activity and renal damage were evaluated at baseline and followed up at 6 and 12 months. Laboratory and immunol- ogy profiles were assessed. Patients were evaluated for predictors of treatment response, renal flares, and renal survival. Results: The patients mean age was 15.12 +/- 4.53 years. Female/male ratio was 10.5:1. 12.9% had treat- ment resistance, 87.1% achieved remission: complete (CR 31.8%) and partial (PR 55.2%) within 1st year. 27 (31.8%) developed a relapse within the 1st year (9 after CR and 18 after PR). Nephrotic range protein- uria persisted in 24 (28.2%) patients (13 PR and the 11 non -responders). Baseline hypertension (p = 0.034), persistent nephrotic range proteinuria (<0.001) and PR (p < 0.001) were predictive for renal flares. Treatment resistance (p = 0.021), disease relapse (p < 0.001), persistent nephrotic range proteinuria (p < 0.001) were predictors of ESRD, especially in males (p = 0.035). Autoimmune profile and histopathol- ogy class showed insignificant differences among groups. Conclusion: Prevention and aggressive management of hypertension, proteinuria and renal flares is expected to prevent progression to ESRD in lupus nephritis in adolescent and young adult SLE patients. (c) 2020 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).