Long-term activity index after renal failure in a cohort of 32 patients with lupus nephritis

To characterise long-term activity levels after renal failure (RF) in lupus patients.

A retrospective activity analysis was performed of 32 lupus nephritis (LN) patients in RF over a maximum of 34 years. Activity was recorded every 6 months using the BILAG index and serological involvement (SI) (C3 and anti-dsDNA antibodies). 'Inactive' disease was defined as no BILAG A/B and no SI, 'moderate disease' as at least BILAG 1A/ 2B or 'major' SI (C3<0.73g/L and/or anti-dsDNA>149IU/ml, and 'severe' as both BILAG 1 A/2B and major SI. Patients on dialysis (n=32) were compared to patients who had a renal transplantation (n=14).

In the dialysis group, 12.5% were inactive and 87.5% had at least mild-moderate activity (92.8% due to SI; 85.7% due to clinical activity) of which 37.5% demonstrated severe activity. BILAG involvement was mainly haematological (59.4%) and mucocutaneous (25%). In the renal transplantation group, 92.8% were active (100% due to SI, 84.6% due to clinical activity) of which 28.6% displayed severe activity. BILAG involvement was mainly haematological (57.1%) and renal (50%).

Although lupus activity is highly prevalent after RF, when a more restrictive cut off is established, activity decreases from 87.5% to 37.5% in the dialysis group and 92.8% to 28.6% in the renal transplantation group. Serological markers and haematological BILAG activity were the predominant indicators for post-RF lupus activity. We were unable to rule out whether activity derived from an intercurrent process or was intrinsic to the renal failure itself.