Abstract：
Renal involvement of systemic lupus erythematosus needs aggressive treatment. Despite the development of multiple international guidelines, differences in practices exist. This study aimed to explore the current practices of pediatric rheumatologists and nephrologists for the diagnosis, management, and monitoring of lupus nephritis (LN) in Saudi Arabia through a survey. Among the 61 respondents, 54.1% were pediatric nephrologists and 49.9% were pediatric rheumatologists. Predominantly, the participating physicians received training either nationally (57%) or in North America (45%). Most of the respondents (77%) did not have a combined rheumatology-nephrology clinic, primarily because of space or time limitations (75%), or a lack of the other specialty (13%). In terms of the decision to request a renal biopsy, the most common factors were nephrotic-range proteinuria (85%) and a lower level of proteinuria associated with hypocomplementemia or elevated anti-double-stranded (ds) DNA (73%). There was marginal agreement over monitoring the disease\'s activity and treatment response; Complements 3 and 4, anti-dsDNA, protein-creatinine ratio, and estimated glomerular filtration rate were the most popular parameters. The main reason for repeating a renal biopsy was a new renal manifestation that was inconsistent with the previous biopsy. There was considerable variability in the induction therapies used to initiate and taper corticosteroids and conventional immunosuppressive drugs. Most respondents (91%) used angiotensin-converting enzyme agents to control proteinuria. Considerable agreement exists among Saudi physicians managing children with LN but significant variations exist regarding the therapeutic strategies. Additional endeavors are needed to establish a unified national clinical approach for managing LN in children.
摘要：
系统性红斑狼疮的肾脏受累需要积极治疗。尽管制定了多种国际准则，实践中存在差异。本研究旨在探讨目前儿科风湿病学家和肾脏病学家的诊断方法,管理,并通过调查监测沙特阿拉伯的狼疮性肾炎（LN）。在61名受访者中，54.1%为小儿肾脏病学家，49.9%为小儿风湿病学家。主要是,参与的医师在全国(57%)或北美(45%)接受了培训.大多数受访者（77％）没有风湿病-肾病联合诊所，主要是因为空间或时间的限制（75%），或缺乏其他专业（13％）。就要求肾活检的决定而言，最常见的因素是肾病性蛋白尿(85%)和与低补体血症或抗双链(ds)DNA升高相关的较低水平的蛋白尿(73%).Therewasmarginalagreementovermonitoringthedisease\'sactivityandtreatmentresponse;complementations3and4,anti-dsDNA,蛋白-肌酐比值,估计的肾小球滤过率是最受欢迎的参数。重复肾活检的主要原因是新的肾脏表现与先前的活检不一致。用于启动和减少皮质类固醇和常规免疫抑制药物的诱导疗法存在相当大的差异。大多数受访者（91％）使用血管紧张素转换酶药物来控制蛋白尿。管理LN儿童的沙特医生之间存在相当大的共识，但在治疗策略方面存在重大差异。需要进一步努力建立统一的国家临床方法来管理儿童LN。
