Māori and Pasifika children with lupus nephritis are more likely to experience end-stage kidney disease and mortality compared with non-Māori/non-Pasifika (NMNP) children, according to a retrospective chart review. The review included 42 children diagnosed with biopsy-proven lupus nephritis seen by the Starship Hospital and Kidz First paediatric rheumatology and/or Starship renal services between January 1992 and January 2018. Māori and Pasifika children were significantly more likely to develop class 4 lupus nephritis (relative risk 11.3; 95% CI 3.84-49.9; p<0.0001), demonstrate medication nonadherence (relative risk 12.4; 95% CI 3.48-85.7; p<0.0001), and experience end stage kidney disease (reIative risk 15.7; 95% CI 2.97-389.3; p=0.0003) and mortality (relative risk 11.1; 95% CI 1.91-280.1; p=0.005) compared with NMNP children. In addition, chronic histological changes developed more rapidly in Māori children than Pasifika or Asian children (p=0.038).