{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:12:24Z","timestamp":1777929144969,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["CRN-2020-007"],"award-info":[{"award-number":["CRN-2020-007"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["P50DK114786"],"award-info":[{"award-number":["P50DK114786"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23-HL148539"],"award-info":[{"award-number":["K23-HL148539"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the potential of a multi-institutional pediatric learning health system for comparative effectiveness research in pediatric-onset systemic lupus erythematosus (SLE), we characterized renin angiotensin aldosterone system (RAAS) inhibitor utilization and the feasibility of ascertaining key treatment indications and outcomes, including hypertension and proteinuria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We identified children with SLE and lupus nephritis (LN) at 6 PEDSnet institutions using previously developed computable phenotypes. A reference population of controls without SLE was randomly sampled from the same rheumatology\/nephrology clinics (\n                      <jats:italic>N<\/jats:italic>\n                      = 200 controls per site). We evaluated data completeness, plausibility, and conformance related to RAAS inhibitor treatment indications and outcomes: (a) percent of encounters with blood pressure (BP) readings, (b) percent of BP readings with paired height, (c) percent of patients with \u22651 urinalysis within 7 days of SLE diagnosis, (d) urinalyses for which proteinuria could be classified as normal or abnormal, and (e) RAAS inhibitor use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 1303 patients with SLE, including 457 with LN. BP measurements were available at 62% of encounters, of which 96% were paired with a height within 90 days. BP distributions were higher in patients with SLE and LN compared to controls without SLE. One third of SLE patients had a hypertension diagnosis. 60%\u201383% of patients at each site had a urinalysis protein measurement within 7 days of SLE diagnosis. A normal or abnormal result for proteinuria could be derived for 96% of measurements, and nearly all patients with LN had \u22651 abnormal result (range 94%\u2013100% by site). RAAS inhibitors were prescribed to 31% of SLE and 71% of LN patients (range 60%\u201384% by site). Hypertension, elevated BP or proteinuria was identified in 90% of SLE cases at the time of RAAS inhibitor initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We demonstrated the feasibility of ascertaining health measurement data relevant to pediatric lupus treatment and outcomes in a pediatric learning health system, as well as hospital-level variation in RAAS inhibitor use. This work will facilitate more efficient multi-institutional comparative effectiveness research and also highlights opportunities for increased treatment standardization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033251345201","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T17:24:00Z","timestamp":1747761840000},"page":"832-843","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Hypertension, proteinuria, and RAAS inhibition use in children with systemic lupus erythematosus: Data from a multi-institutional pediatric learning health system"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1691-4814","authenticated-orcid":false,"given":"Joyce C.","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Immunology, Boston Children\u2019s Hospital, Harvard Medical School, Boston, MA, USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meredith A.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy Goodwin","family":"Davies","sequence":"additional","affiliation":[{"name":"Applied Clinical Research Center, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitchell","family":"Maltenfort","sequence":"additional","affiliation":[{"name":"Applied Clinical Research Center, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid Y.","family":"Luna","sequence":"additional","affiliation":[{"name":"Applied Clinical Research Center, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanieh","family":"Razzaghi","sequence":"additional","affiliation":[{"name":"Applied Clinical Research Center, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas R.","family":"Dharnidharka","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Hypertension and Apheresis, Washington University and St Louis Children\u2019s Hospital, St Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph T.","family":"Flynn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA"},{"name":"Division of Nephrology, Seattle Children\u2019s Hospital, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William E.","family":"Smoyer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children\u2019s Hospital, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark M.","family":"Mitsnefes","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley P.","family":"Dixon","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Children\u2019s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline A.","family":"Gluck","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Sidney Kimmel Medical College at Thomas Jefferson University, Nemours Children\u2019s Health, Wilmington, DE, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Scobell","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Clinical Futures, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. Charles","family":"Bailey","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Applied Clinical Research Center, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan L.","family":"Furth","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher B.","family":"Forrest","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Applied Clinical Research Center, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle R.","family":"Denburg","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine at the University of Pennsylvania, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Clinical Futures, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8991-8277","authenticated-orcid":false,"given":"Scott E.","family":"Wenderfer","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, University of British Columbia, BC Children\u2019s Hospital, Vancouver, CA, USA"},{"name":"Pediatric Nephrology, Baylor College of Medicine, Texas Children\u2019s Hospital, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214802"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2021.09.032"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/lrh2.10243"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000602"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2019040365"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-061363"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-023-05077-y"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.07810621"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211898"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21664"},{"key":"e_1_3_7_12_2","article-title":"EULAR recommendations for the management of systemic lupus erythematosus: 2023 update","author":"Fanouriakis A","year":"2023","unstructured":"Fanouriakis A, Kostopoulou M, Andersen J, et al. 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