{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:33:28Z","timestamp":1793316808799,"version":"4.5.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020412","name":"Humanitas Research Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020412","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background and hypothesis<\/jats:title>\n                    <jats:p>Lupus nephritis (LN) presents with varied outcomes depending on the age at diagnosis. We aimed to evaluate long-term kidney survival across three age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients were categorized based on their age at lupus nephritis diagnosis: \u226418 years (childhood), &amp;gt;18 to &amp;lt;45 (adulthood), and \u226545 years (elderly). The three groups\u2019 CKD (eGFR &amp;lt;60 ml\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      for at least 3 months) or death-free survival was estimated using Kaplan\u2013Meier curves and compared with the log-rank test. To evaluate the independent prognostic role of age, adjusted for other predictors of chronic kidney disease (CKD) or death, we used multivariate Cox regression analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed 260 patients followed for a median of 14.8 years. Of them, 46 (17.7%) were &amp;lt;18, 173 (66.5%) &amp;gt;18 and &amp;lt;45, and 41 (15.8%) \u226545 years old. 46% of elderly vs. 32.6% of children and 24.3% of adults had acute kidney disease (AKD) at diagnosis (P=0.02). Children had more active SLE, whereas the elderly had more chronic damage and hypertension. At 5, 10, and 20 years, CKD or death-free survival rates were 95.3%, 92.5%, and 88.4% in children; 98.2%, 90.1%, and 82.6% in adults; and 87.5%, 67.8%, and 53.5% in the elderly, respectively. Survival in elderly patients was significantly worse compared with children and adults (P= 0.001), whereas survival rates between children and adults were comparable (P = NS). At multivariate analysis, when the chronicity index was excluded from the model, older age emerged as an independent predictor of CKD or death (relative risk, RR: 3.278; CI: 1.402\u20137.662; P=0.006), with AKD (RR: 2.930; CI: 1.674\u20135.130; P&amp;lt;0.001), arterial hypertension (RR: 3.692; CI: 1.844\u20137.389; P&amp;lt;0.001), SLICC &amp;gt;0 (RR: 1.824; CI: 1.155\u20132.881; P=0.01), and failure to achieve complete remission at 1 year (RR: 4.784; CI: 2.355-9.716; P&amp;lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While children and adults demonstrate comparable long-term kidney survival, elderly patients face significantly worse outcomes due to advanced chronicity and systemic damage. These findings highlight the need for tailored interventions in late-onset LN. Older-onset LN, in fact, was an independent predictor of CKD or death together with AKD, arterial hypertension, SLICC &amp;gt;0, and no remission at 1 year.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1531675","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T03:03:15Z","timestamp":1741834995000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Long-term prognosis of lupus nephritis: comparison between pediatric, adult, and advanced age 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