Approach to Membranous Lupus Nephritis: A Survey of Pediatric Nephrologists and Pediatric Rheumatologists

Alexis Boneparth; Suhas M Radhakrishna; Larry A Greenbaum; Eric Yen; Daryl M Okamura; Jennifer C Cooper; Sherene Mason; Deborah M Levy; Sangeeta D Sule; Paul T Jensen; Cagri Yildirim-Toruner; Stacy P Ardoin; Scott E Wenderfer

doi:10.3899/jrheum.170502

Approach to Membranous Lupus Nephritis: A Survey of Pediatric Nephrologists and Pediatric Rheumatologists

J Rheumatol. 2017 Nov;44(11):1619-1623. doi: 10.3899/jrheum.170502. Epub 2017 Sep 15.

Authors

Alexis Boneparth^{1

2}, Suhas M Radhakrishna^{3

4}, Larry A Greenbaum^{3

4}, Eric Yen^{3

4}, Daryl M Okamura^{3

4}, Jennifer C Cooper^{3

4}, Sherene Mason^{3

4}, Deborah M Levy^{3

4}, Sangeeta D Sule^{3

4}, Paul T Jensen^{3

4}, Cagri Yildirim-Toruner^{3

4}, Stacy P Ardoin^{3

4}, Scott E Wenderfer^{3

4}

Affiliations

¹ Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. [email protected].
² A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine. [email protected].
³ Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁴ A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine.

PMID: 28916546
DOI: 10.3899/jrheum.170502

Abstract

Objective: To describe treatment practices for childhood pure membranous lupus nephritis (MLN).

Methods: Survey study of Childhood Arthritis and Rheumatology Research Alliance and American Society of Pediatric Nephrology members.

Results: There were 117 respondents who completed the survey (60 pediatric nephrologists, 57 pediatric rheumatologists). Steroids and nonsteroid immunosuppression (NSI) were routinely used by the majority for MLN. Mycophenolate mofetil was the favored initial NSI. Nephrologists used steroids (60% vs 93%) and NSI (53% vs 87%) less often than did rheumatologists for MLN without nephrotic syndrome (NS).

Conclusion: Pediatric rheumatologists and nephrologists both recommend steroids and NSI for children with MLN, with or without NS.

Keywords: LUPUS NEPHRITIS; PEDIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS; PHYSICIAN PRACTICE PATTERNS.

MeSH terms

Child
Female
Health Care Surveys
Humans
Immunosuppressive Agents / therapeutic use*
Lupus Nephritis / drug therapy*
Male
Mycophenolic Acid / therapeutic use*
Nephrologists
Pediatricians
Practice Patterns, Physicians'*
Rheumatologists

Substances

Immunosuppressive Agents
Mycophenolic Acid