Background/Purpose: Most published studies that have measured activity in patients with lupus nephritis suggest the disease is relatively quiescent after renal failure.

Purpose: To analyze retrospectively the activity index of 32 patients in end-renal stage disease (ESRD) from a cohort of 182 patients with lupus nephritis during dialysis and/or post renal transplant. 

Methods: We used the BILAG index, levels of complement C3 (n = 0.9-1.8 g/L) and anti-DNA antibodies (n = 0-50 IU/ml) to measure the lupus activity every 6 months after the beginning of dialysis and after renal transplant. Inactive disease was defined as no BILAG A/B both C3 and DNA level within the normal range. Mild-moderate disease was defined as at least 1 B in BILAG and/or mild serological involvement (C3 levels= 0.89-0.73 g/L and/or DNA levels= 51-149 IU/ml). We considered patients to be severely activity when at least 1 A or 2 B were present in BILAG and/or major serological abnormality (C3 levels< 0.73 g/L and/or DNA levels >149 IU/L). 

Results: We followed up a cohort of 182 patients with lupus nephritis from January 1978 to February 2012. 32 patients went into ESRD defined as the need of haemodialysis (HD) or peritoneal dialysis (CAPD). Ethnically, 37,5% were Afrocaribbean, 25% from the Indian subcontinent, 28% Caucasian and 9,4% others. The duration of follow up during ESRD dialysis ranged from 1 to 144 months (median 24, IQR 12-54). 14 of them had a renal transplant. We divided our cohort in two groups: 1) all patients in ESRD (n=32). 2) Transplant patient (n=14). Group 1: 15.1% of the measurements showed completely inactive disease and 84.9% had at least mild-moderate activity at some time (58.5% had both BILAG index and serological involvement, 26.3% only serological involvement, 16.95% only activity by BILAG. Severely active disease only was present in 54.7% of them (34.2% BILAG and serological, 50% serological, 15.8% only BILAG activity). The BILAG involvement was haematological (29.6%), musculoskeletal (19.7%), mucocutaneous (15.5%), constitutional (11.3%), neurological (8.4%) and gastrointestinal (1.4%). 12 patients died. Group 2: 42.3% of the measurements showed inactive disease and 57.7% had at least one flare in this period (43.3% BILAG and serological, 23.3% serologically, 33,3% by BILAG). Severe activity markers were present in only 26.92% (50% BILAG and serological, 32,14% BILAG, 17.9% serologically). The BILAG involvement in this group was due to renal alteration (34%), haematological (30%), constitutional (10%), neurological and cardiovascular (8% each), mucocutaneous (6%), musculoskeletal and gastrointestinal (2%) each. 2 patients died.

Conclusion: We report a 34 years follow-up of a cohort of 32 patients with SLE nephritis in renal failure. The activity after ESRD was much lower in the group of transplant patients. Serological activity was the main finding in both groups.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/activity-index-after-renal-failure-in-a-cohort-of-32-patients-with-lupus-nephritis/