Ethnicity Variation in the Treatment of Pediatric Lupus Nephritis

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Ethnicity Variation in the Treatment of Pediatric Lupus Nephritis

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 11, Issue 2

Abstract

Systemic lupus erythematosus (SLE) is known as a complex autoimmune disorder which is characterized by chronic systemic inflammation resulting from antibodies directed against self-antigens, immunity dysfunction and immune complex formation affecting multi-organ system. Lupus nephritis (LN) is a serious component of SLE in which 40-80% are diagnosed in childhood and exerts adverse impact on long-term renal and patient survival. African-Americans (AA), Hispanics, Asians, and non-Caucasians are high-risk populations with higher prevalence and severe disease. Despite the similarities in adults, childhood-onset LN tends to have more active onset and severe disease activity requiring timely recognition and proper treatment. Over the past 2 decades, huge progress has been made in the treatment of childhood LN. Ethnicity has a quite well-defined effect on the response to treatment for which special considerations must be taken in treatment strategy. This review will discuss the current therapies of LN in clinical practice and shows a comparison of treatment responses in different ethnicities.About 10% to 20% of SLE cases are diagnosed during childhood which uses 18 years as the upper cutoff age in most of the studies [1]. The kidney involvement i.e. lupus nephritis (LN) is a serious component of SLE which presents with proteinuria, microscopic hematuria and renal dysfunction thereby exerting adverse impact on long-term renal and patient survival. Up to 40 to 80% of SLE children will develop LN during their disease course. The incidence rates per 100,000 Medicaid-Enrolled children per year for LN was estimated to be higher in Asians (2.08), African-Americans (AA) (0.87) and Hispanics (0.85) as compared with Whites (0.30) [2]. In the same study, prevalence rates per 100,000 children per year are higher among Asians (11.21), AA (5.79), Hispanics (4.30) as compared with Whites (1.19). LN in children, in contrast to adult-onset, have earlier and more aggressive disease activity with high prevalence and relatively poor response to treatment which leads to poor quality of life [3-5]. With the use of standardized treatment based on guidelines, response to treatment still shows variation between different ethnicities. Ethnicity has a major effect in the disease prevalence, clinical manifestations, severity, and response to treatment in SLE indicating that AA, Hispanics, Asians, and non-Caucasians are more prone to the disease severity [6-8]. This review summarizes the current treatment of LN in clinical practice and compares the responses in different ethnic groups.

Authors and Affiliations

Aanchal Shrestha, Ruochen Che, Zhang Aihua

Keywords

Lupus Nephritis; Systemic Lupus Erythematosus; Pediatric; Ethnicity; Immunosuppressive Treatment; Zhang Aihua Lupus nephritis Rituximab Hydroxychloroquine Mycophenolate mofetil Calcineurin inhibitors Azathioprine RCTs RTX Angiotensin Adjunctive therapy

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EP ID EP592345
DOI 10.26717/BJSTR.2018.11.002062
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