Lupus nephritis is an important manifestation of systemic lupus erythematosus, which leads to chronic kidney disease, kidney failure, and can result in mortality. About 35%–60% of children with systemic lupus erythematosus develop kidney involvement. Over the past few decades, the outcome of patients with lupus nephritis has improved significantly with advances in immunosuppressive therapies and clinical management. Nonetheless, there is a paucity of high-level evidence to guide the management of childhood-onset lupus nephritis, because of the relatively small number of patients at each centre and also because children and adolescents are often excluded from clinical trials. Children and adults differ in more ways than just size, and there are remarkable differences between childhood- and adult-onset lupus nephritis in terms of disease severity, treatment efficacy, tolerance to medications and most importantly, psychosocial perspective. In this article, we review the ‘art and science’ of managing childhood-onset lupus nephritis, which has evolved in recent years, and highlight special considerations in this specific patient population.

狼疮性肾炎是系统性红斑狼疮的重要表现，可导致慢性肾脏病、肾衰竭，并可导致死亡。大约 35%–60% 的系统性红斑狼疮儿童会出现肾脏受累。在过去的几十年里，随着免疫抑制治疗和临床管理的进步，狼疮性肾炎患者的预后得到了显着改善。尽管如此，由于每个中心的患者数量相对较少，而且儿童和青少年经常被排除在临床试验之外，因此缺乏指导儿童期狼疮肾炎治疗的高水平证据。儿童和成人的差异不仅仅是体型大小，儿童和成人发病的狼疮性肾炎在疾病严重程度、治疗效果、药物耐受性以及最重要的社会心理方面也存在显着差异。在本文中，我们回顾了近年来发展的儿童期狼疮性肾炎治疗的“艺术与科学”，并强调了针对这一特定患者群体的特殊考虑因素。