Table 1 Renal response criteria in global systemic lupus erythematosus scoring tools
Scale | Time period | Scoring | Renal response criteria | Strengths and criticisms [ 18 ] |
|---|---|---|---|---|
Disease activity | ||||
SLEDAI-2K [45] | 10 days | • The presence of each of the renal manifestations adds 4 points to patient’s total score. | • Urinary casts (heme-granular or RBC) | ✓ Validated for clinical and research use |
• Hematuria (>5 RBCs/hpf) |   ○ Does not capture improving or worsening | |||
• Proteinuria (>0.5 g/24 hours, new onset or increase of >0.5 g/24 hours) |   ○ Must wait for labs to score | |||
• Pyuria (>5 WBCs/hpf, excluding infection) | ||||
BILAG [46] | One month | • Category A (severe disease) = ≥2 of the following: | • Blood pressure | ✓ Incorporates an element of change |
1. Proteinuria, defined as | • Accelerated hypertension? | ✓ Sensitive to small changes | ||
  (a) urinary dipstick increased by 2 or more levels | • Proteinuria (on either dipstick or 24-hour collection) | ✓ Can identify if disease improving, stable, or worse | ||
  (b) 24 urinary protein rising from <0.20 to >1 g |   ○ >1 g/24 hours? | ± scoring can be complex (computer program available) | ||
  (c) 24 hour urinary protein rising from >1 g by 100% |   ○ UPCR >100 mg/mmol? | |||
  (d) newly documented proteinuria of >1 g | • Nephrotic syndrome? |   ○ Requires formal training | ||
2. Accelerated hypertension | • Creatinine |   ○ Developed for research | ||
3. Deteriorating kidney function, defined as | • Creatinine clearance/GFR |   ○ Up to 50 minutes to complete | ||
  (a) plasma creatinine >130 μmol/L and having risen to >130% | • Active urinary sediment (>5 WBCs/hfp, >5 RBCs/hpf, or RBC casts) |   ○ Must wait for labs to score | ||
  (b) creatinine clearance fallen to <67% of previous value | • Histologic evidence of nephritis in the previous 3 months? (excludes sclerosis) | |||
  (c) creatinine clearance <50 mL/min, and last time was >50 mL/min or was not measured | ||||
4. Active urinary sediment | ||||
5. Histological evidence of active nephritis | ||||
• Category B (moderate disease) = one of the following: | ||||
1. Any one of the category A criteria above | ||||
2. Proteinuria | ||||
  (a) urinary dipstick which has risen by 1+ or >2+ | ||||
  (b) 24-hour urinary protein rising from >1 g by >50% but <100% | ||||
3. Plasma creatinine >130 μmol/L and having risen 115% | ||||
ECLAM | One month | • 0.5 points for each renal criteria present | • Proteinuria ≥500 mg/day | ✓ Derived from a large number of real patients and standardized data |
• 2 extra points added if only kidney involvement | • Urinary casts (RBCs, hemoglobin, granular, tubular, or mixed) | ✓ Easy to administer and scor | ||
• 2 points for evolving manifestations (if any renal symptom new or worse since last evaluation) | • Hematuria (micro- or macro-scopic) |   ○ Global score will miss changes in severity over time | ||
• Raised serum creatinine or reduced creatinine clearance | ||||
SLAM-R | One month | • Hypertension (diastolic pressure, mm Hg) | No specific renal response criteria but the following components are renal-related: | ✓ Evaluates activity and severity |
  - 0: <90 | • Hypertension | ✓ Computerized version available | ||
  - 1: 90-104 | • Raised serum creatinine or reduced creatinine clearance |   ○ Lacks immunologic markers | ||
  - 2: 105-114 | • Severity of urine sediment analysis per high-power field |   ○ Not used in major ongoing clinical trials | ||
  - 3: >115 | ||||
  - Unknown | ||||
• Serum creatinine or creatinine clearance (% normal) | ||||
  - 0: 0.5-1.0 or 80%-100% | ||||
  - 1: 1.4-2.0 or 60%-79% | ||||
  - 2: 2.1-4.0 or 30%-59% | ||||
  - 3: >4.0 or <30% | ||||
  - Not recorded | ||||
• Urine sediment | ||||
  - 0: normal | ||||
  - 1: 6-10 RBCs or WBCs OR 0-3 granular or non-RBC casts OR trace-1+ protein (<500 mg/L 24-hour urine protein) | ||||
  - 2: 11-25 RBCs or WBCs OR >3 granular or non-RBC casts OR 2-3+ protein (>500 mg to 3.5 g/L 24-hour urine protein) | ||||
  - 3: >25 RBCs or WBCs OR any RBC casts OR 4+ protein (>3.5 g/L 24-hour urine protein) | ||||
Disease damage | ||||
SLICC/ACR Damage Index [47] | Cumulative damage index | 1 point for satisfying GFR or proteinuria | • Estimated or measured GFR <50% | ✓ Ability to assess accumulated damage |
3 points if ESKD | • Proteinuria ≥3.5 g/24 hours | ✓ Prognostic tool | ||
• ESKD |   ○ Recommended for clinical trials to describe population | |||
  ○ Accuracy depends on information available | ||||