Risk factors associated with renal disease progression:
(1) persistent hypertension (more than 6 months after starting therapy)
(1a) greater than 118/78 for ages 6 to 10 years
(1b) greater than 124/82 for ages 11 to 13
(1c) greater than 136/86 for ages 14 to 18
(2) anemia (hemoglobin < 10 g/dL)
(3) increased serum creatinine concentration (> 1 mg/dL)
(4) decreased creatinine clearance at time of initial renal biopsy (< 75 mL per minute per square meter BSA)
(5) low titer for CH50 hemolytic assay (< 25 U/mL)
(6) advanced renal pathology (WHO Class IV) at initial renal biopsy
where:
• The CH50 is an assay of total complement activity. It reflects the reciprocal of the dilution of patient serum required to hemolyze 50% of sensitized sheep red blood cells. A low titer indicates low complement levels and more active autoimmune disease.
• A low CH50 titer was the primary risk factor associated with increased mortality.
