Đặc điểm lâm sàng và cận lâm sàng của viêm thận lupus ở trẻ nam tại Bệnh viện Nhi Trung ương

Abstract

Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE). Lupus nephritis in male patients is generally associated with greater disease activity and more severe renal manifestations. A case-series study was conducted on 55 male patients younger than 16 years old, diagnosed with lupus nephritis and treated at Vietnam National Children’s Hospital between January 2021 and January 2026. The mean age at diagnosis was 11.24 ± 2.17 years old. The most common extrarenal manifestations were skin rash (49.1%), prolonged fever (47.3%), and hepatosplenomegaly and/or lymphadenopathy (45.5%). Edema was present in 60.0% of patients, while hematuria was observed in 90.9%. More than 90% of patients had nephrotic-range proteinuria, including 56.4% with nephrotic syndrome. Reduced estimated glomerular filtration rate (eGFR < 90 mL/min/1.73 m²) was found in 40.0% of patients, of whom 21.8% had eGFR < 60 mL/min/1.73 m². Positive antinuclear antibodies (ANA), positive anti-double-stranded DNA (anti-dsDNA), low C3, and low C4 levels were detected in 94.5%, 89.1%, 89.1%, and 87.3% of patients, respectively. The mean SLE Disease Activity Index (SLEDAI) score was 21.07 ± 8.15, and 92.7% of patients had high or very high disease activity. Renal biopsy was performed in 26 of 55 patients, with class IV lupus nephritis being the most common histopathological finding (46.2%). Conclusions: Male children with lupus nephritis commonly present with high disease activity, severe renal involvement, and a predominance of proliferative lupus nephritis. Early recognition of these characteristics may facilitate timely diagnosis, risk stratification, and appropriate treatment.