An audit study on the management of children with lupus nephritis admitted to Assiut University Children Hospital

Background
Childhood-onset systemic lupus erythematosus (cSLE) is a severe multisystem autoimmune disease. Renal involvement occurs in the majority of cSLE patients and is often fatal. It occurs in 50–75% of all cSLE patients, mostly within the first 2 years after diagnosis. The aim of this study was to evaluate the management of children with lupus nephritis (LN) admitted to the Pediatric Nephrology and Rheumatology Units, Assiut University Children Hospital according to the guidelines of the American College of Rheumatology and the European League Against Rheumatism (2012), searching for defects, obstacles, or needs to improve the management of such cases.
Patients and methods
Medical records of children with LN admitted to the Nephrology and Rheumatology Units, Assiut University Children Hospital during the period from 1 July 2016 to 30 June 2017 were collected and reviewed to choose the cases which fulfilled the criteria of the study. A structured data collection form was designed to gather clinical, laboratory, and therapeutic data from the included records. This form was designed according to the published guidelines for LN by the American College of Rheumatology and the European League Against Rheumatism (2012).
Conclusion
Data of this study showed a severe defect in recording both the admission and the follow-up historical data of the studied cases. In addition, registered data about the clinical examination of such cases were also defective. Furthermore, the recorded data revealed neglection of important diagnostic investigations, for example, renal biopsy which was performed for only 50% of the studied cases and also evaluation of CH serum level which was not performed on any of the studied cases. The therapeutic regimens which were used for the treatment of the studied cases were random, and did not follow any well-known published guidelines for the treatment of such cases.