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Whether lupus activity is ameliorated by end-stage renal disease (ESRD) or transplantation has been debated. A recent report from Mexico City assessed the frequency and risks for extrarenal flare in SLE patients after renal transplant. A retrospective, case–control study studied 38 SLE cases (who experienced 50 extrarenal flares) and 50 controls seen between 1993 to 2014.
Flares were more common in men and the most common flares were hematologic (42%), mucocutaneous (38%) and articular (30%). Independent risk factors for flares included age at the start of renal replacement therapy [OR 0.92 (95% CI 0.88, 0.96)], history of haematologic activity [OR 3.79 (95% CI 1.05, 13.7)], anti-cardiolipin IgM [OR 4.39 (95% CI 1.32, 14.6)] and low C4 levels [OR 9.7 (95% CI 2.49, 39.12)].
Hence there may be a profile for lupus patients at risk for extrarenal flare after RRT. Closer monitoring may be warranted in younger patients, with history of hematologic disease, anti-cardiolipin antibodies or lower C4 levels.