Yang et al identified factors associated with a poor prognosis in children with lupus nephritis. This can help identify patients with more severe disease who may require closer monitoring and more aggressive management. The authors are from the National Yang-Ming Medical College in Taiwan.


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



• 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.


To read more or access our algorithms and calculators, please log in or register.