Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


33076.pdf (879.76 KB)

ETD Abstract Container

Abstract Header

Establishing Clinical Variables towards the Development of Corticosteroid Treatment Algorithms in Pediatric Proliferative Lupus Nephritis

Chalhoub, Nathalie E
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554214478116667

Abstract Details

2019, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background/Purpose: Corticosteroids (CS) are the mainstay of childhood-onset systemic lupus erythematosus (cSLE) and proliferative lupus nephritis (LN) therapy. However, there are no widely accepted CS dosing regimens for the treatment of LN, although the most intense CS regimens are used for treating renal involvement with cSLE. As a first step to establish CS dosing standards for cSLE, we aim to (1) delineate current practices and (2) identify clinical variables influencing CS dosing, and more specifically oral prednisone dosing in children with newly diagnosed proliferative LN. Methods: Various methods of consensus formation were used, including a modified nominal group technique among pediatric rheumatologists and nephrologists attending the 2018 Childhood Arthritis and Rheumatology Research Alliance (CARRA) LN Work Group who responded to questions on CS use in newly diagnosed pediatric proliferative LN (Step 1), followed by a post-meeting survey (Step 2 ), the generation of patient profiles (PP) using data from the medical records of children with proliferative LN at Cincinnati Children’s Hospital Medical Center (CCHMC) (Step 3), and an online survey among rheumatologists at CCHMC and the University of Cincinnati Medical Center (UCMC) to adjudicate on renal and extra-renal clinical disease courses and estimate prednisone dosing for a given PP (Step 4). PP ratings from the rheumatologists were used to identify clinical variables that correlate with and predict the estimated prednisone doses (Step 5). Results: Responses from the CARRA LN Work Group confirmed that prescribed CS dosing regimens vary widely in the U.S. (Steps 1 and 2). PP survey responses (Steps 3 to 5) showed a high level of agreement among PP raters for renal and extra-renal clinical disease courses when categorized into worsening vs non-worsening disease. The estimated prednisone dose by PP raters is found to be most strongly correlated with the pre-visit prednisone dose (r=0.70). Proteinuria and SLEDAI-2K scores show moderate correlations to the estimated prednisone dose. The highest prednisone dose prescriptions are given to patients with worsening of both renal and extra-renal clinical disease courses. The pre-visit prednisone dose and the PP ratings of renal, extra-renal and combined renal and extra-renal clinical disease courses are found to be the best predictors of prednisone dose estimates using mixed model analysis. Conclusion: Prednisone dosing regimens in children with newly diagnosed proliferative LN depend on physicians’ opinions of renal, extra-renal and the combined clinical disease courses as well as the pre-visit prednisone dose. The identification of clinical variables that correlate with and predict prednisone dosing regimens is key to the future development of CS treatment algorithms in children with proliferative LN.
Aimin Chen, Ph.D. (Committee Chair)
Hermine Brunner, M.D. (Committee Member)
Bin Huang (Committee Member)
49 p.
Surgery
corticosteroids; childhood-onset SLE; prednisone; proliferative lupus nephritis

Recommended Citations

Citations

  • Chalhoub, N. E. (2019). Establishing Clinical Variables towards the Development of Corticosteroid Treatment Algorithms in Pediatric Proliferative Lupus Nephritis [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554214478116667

    APA Style (7th edition)

  • Chalhoub, Nathalie. Establishing Clinical Variables towards the Development of Corticosteroid Treatment Algorithms in Pediatric Proliferative Lupus Nephritis. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554214478116667.

    MLA Style (8th edition)

  • Chalhoub, Nathalie. "Establishing Clinical Variables towards the Development of Corticosteroid Treatment Algorithms in Pediatric Proliferative Lupus Nephritis." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554214478116667

    Chicago Manual of Style (17th edition)

ucin1554214478116667
84
© 2019, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.