Risk factors for hypercreatinemia in patients with systemic lupus erythematosus

Renal insufficiency is one of the most severe outcomes of systemic lupus er ythematosus (SLE). The aim, of this study was to identify baseline predicto rs of the development of renal insufficiency in a cohort of patients with S LE. 281 patients from the The Hopkins Lupus Cohort (HLC) enrolled between 1 987-1994 were followed for the occurrence of renal insufficiency, defined a s a serum creatinine 1.6 mg/dl for men and 1.4 mg/dl for women. Over a mean (+/- s.d.) of 3.3 +/- 2.1 y of follow up, 46 (16%) of the 281 p atients developed renal insufficiency. Using a multivariate Cox proportiona l hazard model, we found the risk of renal insufficiency associated with yo unger (0-19 y) or older (40 y) age at baseline (relative risk (95% CI) 5.1 (1.4, 18.8) and 4.1 (2.1, 8.2)) and longer duration of SLE before referral to the cohort (RR 1.25 [1.05, 1.5] for every five years). Additional predic tive variables were borderline elevation of serum creatinine at baseline (R R 3.1 (1.4, 6.6) for a serum creatinine 1.4-1.5 mg/dl far men and 1.2-1.3 m g/dl for women), and mean proteinuria (RR 3.6 (1.8, 7.4) for trace-3+ and 1 0.6 (3.8, 30.0) for 3+ (urine dipstick level)). Socioeconomic status, race, autoantibodies and complement were not significantly associated with the r isk of renal insufficiency. This study supports early referral of SLE patients to rheumatologists and e mphasizes the importance of early signs of renal involvement as predictors of later renal insufficiency in SLE patients.