Two experts who were not involved in the study agreed that the two specialties need to work together to improve their care of children with LN.
“It makes sense that nephrologists and rheumatologists won’t always agree on these difficult decisions because our training and experiences are different,” said Michael J. Holland, MD, MS, an assistant professor of pediatrics at the University of Missouri–Kansas City School of Medicine and Children’s Mercy Kansas City. “The findings point to a glaring need for more research and consensus building in this vital area.
“This is the largest survey of its kind that I know of, and I love that they surveyed both pediatric rheumatologists and nephrologists,” he said in an email to Reuters Health. “Breaking down barriers between subspecialties is a great way to approach difficult problems like this.
“We desperately need more research and better consensus to guide our approach in treating refractory lupus in children and adolescents,” Dr. Holland added. “I commend the authors for shining a spotlight on this gap in our knowledge, and for breaking down barriers between specialties with their work.”
Nayimisha Balmuri, MD, an assistant professor of pediatrics at Johns Hopkins University School of Medicine and a pediatric rheumatologist at Johns Hopkins Children’s Center, Baltimore, told Reuters Health by email, “It’s important to have interprofessional collaboration between the nephrologists and the rheumatologists to best come up with approaches to holistically treat these children.
“This study highlights the need for clinical trials involving pediatric patients with lupus nephritis so we may have the best evidence to recommend medical treatments in a better-informed way,” she noted.
Reference
Gilbert M, Goilav B, Hsu JJ, et al. Differences in rituximab use between pediatric rheumatologists and nephrologists for the treatment of refractory lupus nephritis and renal flare in childhood-onset SLE. Pediatric Rheumatology. 2021 Aug 30;19(137).
