title: Analysis of lupus activity in end-stage renal disease treated by hemodialysis.
abstract: OBJECTIVE
  The activity of systemic lupus erythematosus (SLE) has been reported to decrease in patients who have developed end-stage renal disease (ESRD). However, extrarenal symptoms attributable to the disease activity are noted, especially during the first year of dialysis. We studied the clinical course and evaluate the disease activity of SLE in patients with ESRD on hemodialysis for more than 6 months.
  
  
  METHODS
  Fourteen patients with SLE who had been initiated on maintenance dialysis at our center between 1982 and 1999 were examined retrospectively. Their clinical details, organ system manifestations, serologic profiles and immunosuppressive treatment regimens were reviewed. Patients with and without postdialysis flaras of SLE were compared statistically.
  
  
  RESULTS
  Five patients exhibited 6 SLE flares under treatment with corticosteroids. Two flares occurred within the first year of the initiation of dialysis, and in 1 patient, aggravation of the disease activity was noted 98 months after the initiation of dialysis. Polyarthritis was noted in 5 cases and fever in 4 cases. The serum complement levels decreased in all 6 cases with relapse of SLE activity. Compared with the other 9 patients who did not exhibit SLE relapse, no significant differences were found in 5 patients who did with respect to the demographic and serologic features at the initiation of dialysis.
  
  
  CONCLUSIONS
  We conclude that the disease activity does not always burn out in patients of SLE who show progression to ESRD. SLE flares can sometimes occur even after one year of the initiation of dialysis. SLE patients on dialysis should be carefully followed up by clinical and serological monitoring, and treated by appropriate immunosuppressive therapy.
authors.affiliation: Department of Medicine, Kidney Center, Tokyo Women's Medical University.
authors.forename: K
authors.initials: K
authors.lastname: Okano
authors.forename: W
authors.initials: W
authors.lastname: Yumura
authors.forename: K
authors.initials: K
authors.lastname: Nitta
authors.forename: K
authors.initials: K
authors.lastname: Uchida
authors.forename: T
authors.initials: T
authors.lastname: Ohnuki
authors.forename: A
authors.initials: A
authors.lastname: Kawashima
authors.forename: H
authors.initials: H
authors.lastname: Nihei
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents