Elevated C-reactive protein and failure to achieve remission in pediatric lupus nephritis: A retrospective cohort study

Lupus nephritis (LN) is a serious complication that adversely affects the prognosis of children with systemic lupus erythematosus. However, short-term prognostic indicators for LN in this population remain unclear. This retrospective cohort study aimed to identify factors associated with treatment remission in Chinese children with LN, with a focus on inflammatory markers. We included 72 children aged 0 to 18 years diagnosed with LN at our center between January 2022 and December 2024. Partial remission was defined as a ≥50% reduction from baseline in proteinuria and to an absolute value of <3.0 g/g (300 mg/mmol), measured as the protein-to-creatinine ratio from a 24-hour urine collection, accompanied by stabilization or improvement in kidney function (estimated glomerular filtration rate, eGFR, within ±10% to 15% of baseline). The non-remission group comprised patients who failed to meet the above partial remission criteria within the 8 to 24 week follow-up period. Both univariate and multivariate Cox regression analyses revealed that elevated C-reactive protein (CRP) levels were significantly associated with failure to achieve remission (univariate hazard ratio 1.067, 95% CI: 1.011–1.126, P = .019; multivariate hazard ratio 1.075, 95% CI: 1.019–1.134, P = .008). A nomogram incorporating CRP demonstrated moderate discriminatory capacity for remission status at 24 weeks (AUC = 0.739). These findings indicate that baseline CRP is an independent risk factor for short-term remission failure in pediatric LN, suggesting that its monitoring may be beneficial for guiding clinical interventions. In conclusion, elevated CRP is an independent risk factor for short-term remission failure, and its monitoring may be beneficial for assessing treatment outcome.