INCREASING INCIDENCE OF CHILDHOOD CLASS-V LUPUS-NEPHRITIS

Objective, Class V lupus nephritis (LN) is reported to occur in 0-23% of patients with LN. To better characterize pediatric LN, we determine d at a single center (1) the relative frequency of Class V LN on first and serial biopsies, (2) the frequency of transformation between LN c lasses on serial biopsies, (3) types of treatment received and outcome to date of different classes of LN. Methods. All pediatric renal biop sies from 1985 to the present performed for diagnosis and classificati on of suspected LN were reviewed. Biopsy results were grouped into 2-3 year time intervals to assess trends in the distribution of WHO class diagnoses over time. Results. Sixty patients underwent 97 renal biops ies. Class V LN was present in 28% (17/60) of patients on first biopsy , and in 37% (22/60) on most recent biopsy. Class V LN on first biopsy increased from 17% (8/46) before 1995 to 64% (9/14) after 1995 (p < 0 .001). Age at presentation, age at biopsy, time to biopsy, and types o f treatment did not differ before and after 1995, Transformation to Cl ass V LN occurred in 19% (5/27) of patients having repeat biopsies. No transformation from Class V LN occurred on repeat biopsy. Renal outco me was available in 48 patients with followup of 4.7 +/- 3.2 years for Class V LN, and 5.2 +/- 2.4 years for non-Class V LN. Five percent (1 /20) of Class V LN patients had renal dysfunction or had died compared to 21% (6/28) of non-Class V LN patients (p = NS). Conclusion. We fou nd (1) a greater frequency of Class V LN than has been reported, (2) a recent increase in the incidence of Class V LN at our institution, (3 ) frequent transformation between classes on serial biopsies, and (4) no regression of Class V lesions in patients who had repeat biopsies.