Ethnicity Variation in the Treatment of Pediatric Lupus Nephritis

Aanchal Shrestha¹, Ruochen Che¹ and Zhang Aihua*^1,2

Received: November 05, 2018;   Published: November 19, 2018

DOI: 10.26717/BJSTR.2018.11.002062

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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.

Keywords : Lupus Nephritis; Systemic Lupus Erythematosus; Pediatric; Ethnicity; Immunosuppressive Treatment

Abbreviations : SLE: Systemic Lupus Erythematosus; LN: Lupus Nephritis; AA: African-Americans; CYC: Cyclophosphamide; NIH: National Institutes of Health; IV: Intravenous; ELNT: Euro-Lupus Nephritis Trial; MMF: Mycophenolate Mofetil; RCT: Randomized Controlled Trial; ALMS: Asperva Lupus Management Study; AZA: Azathioprine; CNI: Calcineurin Inhibitors (CNIs); RTX: Rituximab; HCQ: Hydroxychloroquine; ACR: American College of Rheumatology; KDIGO: Kidney Disease Improving Global Outcomes; EULAR: European League Against Rheumatism