Clinical presentation and assessment of disease activity in lupus nephritis

1. There is renal involvement in 35–75% of patients with SLE.2. Relatively few patients develop renal failure and failure of treatment compliance is often a major contributory factor.3. Defining whether renal abnormalities are due to activity, damage or a combination of both is important in guiding treatment.4. General activity indices such as the BILAG or SLEDAI scoring systems, together with more specific indicators (e.g. PCR and the presence of urinary red cells and casts) provide an optimal way of assessing disease activity in a patient with lupus nephritis.5. Renal biopsy remains an essential ‘tool’ in determining the type of lupus involvement, the degree of activity and damage, and the outcome.