{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:07:03Z","timestamp":1784192823373,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Childhood-onset lupus nephritis (cLN) should no longer be framed as a smaller version of adult lupus nephritis. It is a high-stakes pediatric kidney disease in which immune injury, treatment toxicity, growth, puberty, fertility, adherence, and transition to adult care intersect over decades. Approximately 10\u201320% of systemic lupus erythematosus begins in childhood, and 40\u201360% of affected children develop lupus nephritis. Regional cohorts report even higher renal involvement in some populations, including 65\u201373% among Saudi children with SLE. Contemporary guidance has moved from prolonged high-dose glucocorticoids and cyclophosphamide-dominant treatment toward biopsy-driven, treat-to-target care built around mycophenolic acid analogues, hydroxychloroquine, nephroprotection, rapid steroid tapering, and selected belimumab- or calcineurin-inhibitor-based triple therapy. This Viewpoint argues that the central question in cLN is no longer simply how to induce remission, but how to produce a durable kidney response early enough, with sufficiently low cumulative toxicity, to preserve kidney function and childhood development. Pediatric practice must therefore combine adult trial evidence with child-specific caution, explicit adherence strategies, fertility and growth protection, and structured transition planning. The aim should be efficacy without toxicity: not undertreatment, but intelligent, sustainable, developmentally informed treatment.<\/jats:p>","DOI":"10.3390\/children13070930","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T08:08:34Z","timestamp":1784189314000},"page":"930","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Childhood-Onset Lupus Nephritis in the Era of Triple Therapy and Steroid Minimization"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-5609","authenticated-orcid":false,"given":"Mohamed S.","family":"Al Riyami","sequence":"first","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat PC 111, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badria","family":"Al Ghaithi","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat PC 111, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulaiman","family":"Al Saidi","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat PC 111, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3802-4143","authenticated-orcid":false,"given":"Anwar","family":"Al Omairi","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat H5QC+36M, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naifain","family":"Al Kalbani","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Child Health, Royal Hospital, Muscat PC 111, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naji","family":"Al Dhawi","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Child Health, Sultan Qaboos University Hospital, Muscat H5QC+36M, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.kint.2025.05.039","article-title":"Childhood-onset lupus nephritis: Unique aspects and challenges in management","volume":"108","author":"Chan","year":"2025","journal-title":"Kidney Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12969-026-01215-6","article-title":"Expert collaborative evidence-based consensus for childhood lupus nephritis diagnosis and treatment: Unifying clinical approach in Saudi Arabia","volume":"24","author":"AlMutairi","year":"2026","journal-title":"Pediatr. 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