Clinical features, treatment and prognosis were studied in 16 systemic lupus erythematosus (SLE) patients on hemodialysis (HD), aged 24-47 years (1M, 15F). Renal biopsy revealed diffuse lupus nephritis (LN) in 12 and membranous LN in 2.
The patients were divided into 3 groups based on the progress of renal dysfunction. Group A (n=6), rapidly progressive, had short duration from the SLE/LN onset to HD introduction and reached renal dysfunction progressively. With low CH 50 and high immunological activity at HD introduction, high-dose steroids were required and combined with plasma exchange therapy in all, and with pulse therapy in 4. The treatment improved immunological abnormalities and renal functions. Group B (n=3), acute on chronic, was treated similarly to Group A. HD was withdrawn but reintroduced in 2, and the remaining 1 patient died suddenly soon after HD withdrawal. Group C (n=7), chronic, included the patients with disease duration as long as 240 or 180 months from the SLE/LN onset. Chronic LN progressed to renal dysfunction. All had diffuse proliferative LN histologically. Hypertension occurred in all and diabetes mellitus in 2. Compared with Group A, SLE activity evaluated with CH 50 at HD introduction was lower (p<0.01), and the steroid doses required (p<0.001) were lower. SLE recurrence in 3 after HD introduction required an increase in steroid doses. One patient died of cerebral hemorrhage after 10 years of maintenance HD.
In Group A, HD was introduced at lower serum creatinine level (p<0.02) than in Group C. Combination with plasma exchange in all and with pulse therapy in half improved immunological abnormalities and renal functions. In Group C, HD was introduced in the “burn-out” state. SLE recurrence during maintenance HD requires close monitoring. HD in SLE patients is introduced under various conditions. Its prognosis may be improved when combined with other therapies at opportune times, considering the findings of laboratory tests and renal biopsy.