Studies of dialysis treatment in patients with systhemic lupus erythematosus

We investigated retrospectively the clinical features and factors influensing the prognosis in 22 patients with SLE (2 females, 20 males) who were undergoing a hemodialysis treatment in the 2nd department of internal medicine, Nagasaki University and affiliated hospitals from, 1978 to 1989. These cases were divided into 3 groups as follow, A) maintenance hemodialysis (n=14), B) death within 2 months after start of hemodialysis (n=5), C) substantial recovery of renal function by hemodialysis (n=3). The following data were evaluated for these 3 groups: clinical data, periods of treatment before hemodialysis, dosages of steroid, activities of SLE, and renal biopsy findings. The renal biopsies of 17 cases revealed 1 of category II, 2 of category III, 8 of category IV and 6 of category V, of the WHO classification. There was no significant differences in the activity index between the 3 groups, but the chronicity index of group A was higher than that of other groups. In group A, the period of treatment before hemodialysis was long (105 months on average), and the renal function had decreased gradually. The SLE activity was not high, and the steroid dose was a maintenance dose at the start of hemodialysis. It was possible to decrease the dose of steroid or to cease its administration. In group B, the prior period of treatment was short and renal function had decreased rapidly. The SLE activity was high, and the steroid dose was high at the start of hemodialysis. The etiologies of death were infections, DIC and CNS lupus. In group C, the hemodialysis was started at the time of infection, but the SLE activity was not high. The renal function recovered after 14 months in 1 of them, and after 2 weeks in 2 of them, but 2 of them needed hemodialysis again.