Clinical course of lupus membranous glomerulonephritis in children

Background. Lupus nephritis (LN) is not a common renal disorder of childhood. Few pediatric nephrologists, except for those in a large center, see enough patients with LN to build up a substantial amount of experience. Membranous glomerulonephritis (MGN) associated with systemic lupus erythematosus (SLE), so-called lupus membranous glomerulonephritis (LMGN), is also rare in patients with LN. Methods. In 36 children with SLE, we investigated the clinical course of 4 children (1 boy and 3 girls) who showed MGN. Their mean age at presentation was 7.8 years and the mean follow-up period was 7.1 years. Results. Presenting symptoms were chance hematuria and proteinuria (H and P) in 2 children, edema in 1, and petechiae and thrombocytopenia in 1. The initial biopsy showed MGN in 3 children and diffuse proliferative glomerulonephritis in 1 child, in whom transition to MGN was observed. Two patients, who presented with chance H and P and showed MGN on the initial biopsy, later developed clinical signs of SLE, 3 and 5 years after presentation, respectively. During the course, all patients developed nephrotic syndrome, but at the last follow-up, H and P was detected in 1 child and proteinuria in 1 child. Urinalysis results were normal in 2 children. No patient had nephrotic syndrome or developed renal failure. Conclusions. The clinical course of LMGN in the 4 children seemed to be favorable. Two patients with MGN developed clinical signs of SLE several years after the renal manifestation.