Clinical Course, Outcomes and Complications of Thai
Pediatric Pure Type versus Mixed Type Lupus
Membranous Nephritis
Montira Aroonnet MD* Wattana Chartapisak MD***,
Songkiet Suwansirikul MD**, Nattaphorn Hongsawong MD***
Affiliation :
* Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
** Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*** Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University,
Chiang Mai, Thailand
Background : Due to the relative infrequency of lupus membranous nephritis (LMN) compared to other types of lupus nephritis
(LN) in pediatric patients, the current literature on pediatric LMN is limited. The knowledge regarding clinical manifestations,
outcomes and infectious complications are mainly based on studies in the adult population. Similar to disease expression
in SLE, the renal manifestations of LMN are affected by environmental factors and vary among racial and ethnic groups.
Objective : To describing clinical features, common infectious complications, and outcomes of pediatric-onset LMN in Thai-
land and the correlation between pure and mixed types of LMN classified by renal pathology.
Material and Method: This was a retrospective analysis of 40 patients with LMN as seen in the Pediatric Nephrology Clinic,
Maharaj Nakorn Chiang Mai from January, 2003 to December, 2012. Patients were categorized into pure and mixed types
of LMN the comparisons of the clinical course, results of treatment and infectious complications between the two types had
been analyzed and recorded data for 2 years.
Results : Kidney biopsy was performed. Of the 40 patients with LMN, 50% were diagnosed as mixed-type LMN. The clinical
symptoms presented including rash, hypertension, edema, serositis and arthritis were found at 57.7%, 45%, 40%, 25%
and 25% respectively. All of the patients were treated with an immunosuppressive drug such as: Cyclophosphamide, Aza-
thioprine, Cyclosporine or Mycophenolate mofetil, together with systemic steroids. During the two years follow up, every
patient had normal GFR. Twenty nine patients (72.5%) had renal remission in proteinuria with complete remission in 7
patients (17.5%) and partial remission in 22 patients (55%). An average time from the onset to remission was 12 months.
GFR and proteinuria were not significant difference between the two groups after treatment. The infections found in patients
who received cyclophosphamide include herpes infection, salmonellosis, lung abscess, nocardiosis, giardia intestinalis and
cerebral cysticercosis. Furthermore, steroid side effect was avascular necrosis of the hip joint.
Conclusion : The mixed-type LMN patients had a higher blood pressure, higher BUN and positive LE cell than those of the
pure-type LMN patients. Hypertension at initial presentation can be a predictor of proliferative lesion in renal pathology.
However, a proliferative lesion accompanied with LMN does not affect renal outcomes. With similar renal outcomes, the
immunosuppressive with low adverse effects may be considered as a preferable treatment.
Keywords : lupus membranous nephritis, outcomes, complication, pure type, mixed type, LMN
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