Prognostic factors for disease progression and mortality of childhood-onset lupus nephritis in the Philippines: a retrospective cohort study in a tertiary hospital.

Abstract

Background: Lupus nephritis (LN) is a significant cause of morbidity and mortality in pediatric systemic lupus erythematosus (SLE), with more severe disease seen in childhood-onset cases. In low-to-middle-income countries like the Philippines, financial barriers and healthcare limitations exacerbate poor outcomes. This study aims to describe the clinical features, prognostic factors, and outcomes of childhood-onset LN at the Philippine General Hospital.

Methods: A retrospective cohort study was conducted on patients under 19 years diagnosed with LN from January 2014 to December 2021. Clinical, laboratory, treatment, and outcome data were extracted from medical records. Survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression and logistic regression were used to identify predictors of mortality and progression to chronic kidney disease 5 (CKD 5), respectively.

Results: A total of 128 patients were included, with a mean age of 14.4 years at LN diagnosis and a female-to-male ratio of 13.2:1. Only 16% underwent kidney biopsy, mainly due to financial constraints. Treatment delays and poor adherence occurred in 60% and 38% of patients, respectively, largely due to financial hardship and limited healthcare access. The median follow-up was 2.2 years (range, 0.0-8.8 years). Nephrotic range proteinuria (hazard ratio [HR] 2.91), hypertension at diagnosis (odds ratio [OR] 5.57), and failure to achieve early partial response or complete remission (HR 3.69) were significant predictors of poor health outcomes. Twenty five patients (19.5%) died during the observation period with infection as the leading cause of mortality.

Conclusions: Childhood-onset LN remains associated with high morbidity and mortality in the Philippines, highlighting the urgent need for early diagnosis, expanded diagnostic access, infection risk mitigation, early therapeutic response monitoring, and strategies to enhance treatment adherence to improve outcomes.