Research Of Prognosis Factors Lupus Nephritis In Children

Systemic lupus erythematosus(SLE) is a autoimmune disease involving any organ of body,and has a few of clinical manifestations.It is so variable and atypical in clinical manifestations of the blood system that it is easy to misdiagnose.SLE in children often involve kidney,called Juvenile Lupus Nephritis(JLN).kidney damage in children is more common than in adults,it is one of the primarily reasons why patients die.Judging the patient's conditions of SLE,we often use systemic lupus erythematosus disease activity index(SLEDAI) to evaluate them.SLEDAI,which has a high objectivity,is regarded as the golden standard of measuring the activity of the patients of SLE.But,its content of the standard of perfection,which has 24 indicators, is so much that it has some limits in clinical works.This study is a tentative study for SLE in children.It includes three parts:the first part is belong to the investigation of epidemiology which analyse the clinical characters of between the patients of SLE in children and in adult;the second part is to study whether the clinical,laboratory features and renal biopsy parametersto of patients with JLN can obviously effect the survival rate(SR) and renal survival rate (RSR);the third part is to analyse the prognostic risk factors of children with classⅣlupus nephritis.Objectives: 1.To explore the clinical and laboratory features of systemic lupus erythematosus(SLE) in children.2.To assess the contribution of clinical,laboratory,and renal biopsy parametersto predicting the disease outcomes in patients with lupus nephritis(LN) in children.3.To analyse the prognostic risk factors of children with classⅣlupus nephritis.Methods:1.Sixty—three cases of SLE in children were reported.Their first sign and clinical manifestation,involvement of organs and laboratory findings were analyzed and compared with another 107 cases of SLE in adults who were elected at random.2.Sixty—seven cases of LN in children who had biopsy were studied for the survival rate(SR) and renal survival rate(RSR).The clinical and laboratory data were collected and analyzed for the risk of SR and RSR with Cox's model.Renal biopsy variables were assessed to determine whether they contributed additional predictive value for SR and RSR.3.Fifty-seven children with classⅣlupus nephritis were follow-up.All of them were classified according to pathological classifications of lupus nephritis by WHO.The variances,such as treatment models,clinical and laboratory data,selected from factors of P＜0.1 together with the Logistic regression models by stepwise regression method.Results:1.The symptoms of fever,digestion and involvement of central nervous system and heart in children was more common than that in adults,The incidence of decrease of ds-DNA antibody,complement 4 in children was higher than examinations in SLE children have differences to some extent compared with that of adult cases.2.The SR or RSR differences among the six WHO classes achieve statistical significance.Multivariate analysis showed that multivariate Cox stepwise regression analysis,age and numbers of damaged organ influence the the survival rate(SR) of children with lupus nephritis significantly;male,Cr and C4 also influence the renal survival rate(RSR).3.Multivariate logistic regression model in fifty-seven children with classⅣlupus nephritis show that creatinine clearance(Ccr),release-miss,dropsical nephritis is associated with chronical renal failure in children with classⅣlupus nephritis.Conclusion:1.There are some differences about the clinical and laboratory features of systemic lupus erythematosus(SLE) between children and adult.2.The renal survival rate are lower than the patients' survival rate in chidren with lupus nephritis(LN).Our research showed that with the development of dialysis and renal transplantation,the numbers of patient who direatly die of renal failure are becoming less and less.chidren with lupus nephritis(LN) who developed chronical renal failure have high survival rate by dialysis.3.Multivariate Cox stepwise regression analysis showed that the prognositic factors associated with patients'survival rate in chidren with lupus nephritis(LN) are age and more than 3 organs was damaged;the prognositic factors associated with the renal survival rate in chidren with lupus nephritis(LN) are male,Cr and decrease in C4.4.The risk factors,such as creatinine clearance(Ccr),release-miss,dropsical nephritis,is associated with chronical renal failure in children with classⅣlupus nephritis.