Abstract OBJECTIVE: To study feasibility of Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2000) and British Isles Lupus Assessment Group 2004 (BILAG-2004) scoring systems for assessing renal disease activity in children with lupus nephritis (LN). METHODS: The clinical data of 159 children with systemic lupus erythematosus (SLE) and LN were collected, and disease activity was assessed by SLEDAI-2000 and BILAG-2004 scoring systems. The correlations between SLEDAI-2000 and BILAG-2004 scores and 24-hour urinary protein excretion and renal pathology index were analyzed. The SLEDAI-2000 and BILAG-2004 scoring systems were evaluated using ROC curve. RESULTS: Approximately one third (31.5%) of the 159 children had a moderate level of 24-hour urinary protein excretion. Among the 37 patients undergoing renal biopsy, 46.0% had diffuse LN (type Ⅳ). 24-hour urinary protein excretion was positively correlated with both SLEDAI-2000 (r=0.36, P<0.05) and BILAG-2004 scores (r= 0.39, P<0.05). Children with types Ⅰ, Ⅱ, Ⅲ, and Ⅳ LN had pathology activity index (AI) which positively correlated with SLEDAI-2000 scores (r=0.86, 0.88, 0.84, 0.77 respectively; P<0.05) and BILAG-2004 scores (r= 0.88, 0.98, 0.86, 0.89 respectively; P<0.05). SLEDAI-2000 score showed the best correlation with AI in patients with type Ⅱ LN, followed by those with type Ⅰ LN. BIILAG-2004 score showed the best correlation with AI in patients with type Ⅱ LN, followed by those with type Ⅳ LN. The BILAG-2004 scoring system had an area under the ROC curve (AUC) of 0.93, and the SLEDAI-2000 scoring system had an AUC of 0.88. CONCLUSIONS: BILAG-2004 and SLEDAI-2000 scoring systems can be used to assess renal disease activity of patients with LN. The BILAG-2004 scoring system can provide more reliable and comprehensive assessment.
ZHOU Jie-Qing,JIANG Hong. Feasibility of SLEDAI-2000 and BILAG-2004 scoring systems for assessing renal disease activity in children with lupus nephritis[J]. 中国当代儿科杂志, 2012, 14(10): 775-779.
ZHOU Jie-Qing,JIANG Hong. Feasibility of SLEDAI-2000 and BILAG-2004 scoring systems for assessing renal disease activity in children with lupus nephritis[J]. CJCP, 2012, 14(10): 775-779.
[1]Brunner HI, Gladman DD, Ibaoez D, Urowitz MD, Silverman ED. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus[J]. Arthritis Rheum, 2008, 58(2): 556-562.
[2]Tucker LB, Uribe AG, Fernández M, Vilá LM, McGwin G, Apte M, et al. Adolescent onset of lupus results in more aggressive disease and worse outcomes: results of a nested matched case-control study with in LUMINA, a multiethnic US cohort (LUMINA LVII)[J]. Lupus,2008, 17(4): 314-322.
[6]Yee CS, Farewell V, Isenberg DA, Prabu A, Sokoll K, Teh LS, et al. Revised British Isles Lupus Assessment Group 2004 index: a reliable tool for assessment of systemic lupus erythematosus activity[J]. Arthritis Rheum, 2006, 54(10): 3300-3305.
[7]Isenberg DA, Rahman A, Allen E, Farewell V, Akil M, Bruce IN, et al. BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group′s disease activity index for patients with systemic lupus erythematosus[J]. Rheumatology(Oxford), 2005, 44(7): 902-906.
[8]Ehrenstein MR, Conroy SE, Heath J, Latchman DS, Isenberg DA.The occurrence, nature and distribution of flares in a cohort of patients with systemic lupus erythematosus: a rheumatological view[J]. Br J Rheumatol, 1995, 34(3): 257-260.
[10]Gladman DD, Urowitz MB, Kagal A, Hallett D. Accurately describing changes in disease activity in systemic lupus erythematosus[J]. J Rheumatol, 2000, 27(2): 377-379.
[11]Weening JJ, D′Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited[J]. Kidney Int, 2004, 65(2): 521-530.
[12]Strutz F, Muller GA. On the progression of chronic renal disease[J]. Nephron, 1995, 69(4): 371-379.
[13]Hill GS, Delahousse M, Nochy D, Tomkiewicz E, Rémy P, Mignon F, et al. A new morphologic index for the evaluation of renal biopsies in lupus nephritis[J]. Kidney Int, 2000, 58(3): 1160-1173.
[14]Ruggenenti P, Perna A, Remuzzi G; GISEN Group Investigators. Retarding progression of chronic renal disease: the neglected issue of residual proteinuria[J].Kidney Int, 2003, 63(6): 2254-2261.
[15]D′Amico G, Bazzi C. Pathophysiology of proteinuria[J]. Kidney Int, 2003, 63(3): 809-825.
[16]Tencer J, Bakoush O, Torffvit O. Diagnostic and prognostic significance of proteinuria selectivity index in glomerular diseases[J]. Clin Chim Acta, 2000, 297(1-2): 73-83.
[17]Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J, Rohde RD. Factors predictive of outcome in severe lupus nephritis. Lupus Nephritis Collaborative Study Group [J].Am J Kidney Dis, 2000, 35(5): 904-914,
[19]Yee CS, Farewell V, Isenberg DA, Rahman A, Teh LS, Griffiths B, et al. British Isles Lupus Assessment Group 2004 index is valid for assessment of disease activity in systemic lupus erythematosus[J]. Arthritis Rheum, 2007, 56(12): 4113-4119.
[20]Yee CS, Cresswell L, Farewell V, Rahman A, Teh LS, Griffiths B, et al. Numerical scoring for the BILAG-2004 index[J]. Rheumatology(Oxford), 2010, 49(9): 1665-1669.
[21]Yee CS, Farewell V, Isenberg DA, Griffiths B, Teh LS, Bruce IN, et al. The BILAG-2004 index is sensitive to change for assessment of SLE disease activity[J]. Rheumatology(Oxford), 2009, 48(6): 691-695.