Hypertension, proteinuria, and renin angiotensin aldosterone system (RAAS) inhibition use in children with systemic lupus erythematosus: Data from a multi-institutional pediatric learning health system
Authors' conclusion
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.
Study context
- Population
- Children with pediatric-onset systemic lupus erythematosus (SLE) and lupus nephritis (LN) at 6 PEDSnet institutions1,303 SLE patients incl
- Exposure
- Children with SLE and LN vs controls without SLE from the same rheumatology/nephrology clinics
- SLEn = 1,303
- LNn = 457
- Outcome
- Data completeness, plausibility and conformance for RAAS inhibitor treatment indications and outcomes: BP readings per encounter, BP with paired height, urinalysis within 7 days of SLE diagnosis, classifiable proteinuria, RAAS inhibitor use
Methodological detailsmulti-institutional pediatric learning health system (PEDSnet), computable phenotypes, 6 institutions
- Multi-institutional pediatric learning health system (PEDSnet)
- Computable phenotypes
- 6 institutions
Main finding
As reported in the abstract
- Encounters with blood pressure (BP) measurements
- 62%
- BP readings paired with a height within 90 days
- 96%
- Patients with urinalysis protein measurement within 7 days of SLE diagnosis, by site
- 60%-83%
- Measurements with proteinuria classifiable as normal or abnormal
- 96%
- LN patients with ≥1 abnormal proteinuria result, range by site
- 94%-100%
- RAAS inhibitors prescribed, SLE
- 31%
- RAAS inhibitors prescribed, LN
- 71%
- RAAS inhibitor use in LN, range by site
- 60%-84%
- Hypertension, elevated BP or proteinuria at RAAS inhibitor initiation, SLE cases
- 90%
Observational data: associations, not effects.
Further findings
BP distributions
- BP distributions higher in SLE and LN than in controls without SLE
Hypertension diagnosis in SLE
- One third of SLE patients had a hypertension diagnosis
Original publication
Hypertension, proteinuria, and RAAS inhibition use in children with systemic lupus erythematosus: Data from a multi-institutional pediatric learning health system. Lupus. Published 20 May 2025. doi:10.
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