Table 1.

Renal response criteria in global systemic lupus erythematosus scoring tools

Scale	Time period	Scoring	Renal response criteria	Strengths and criticisms [ 18 ]
Disease activity
SLEDAI-2K [45]	10 days	• The presence of each of the renal manifestations adds 4 points to patient’s total score.	• Urinary casts (heme-granular or RBC)	✓ Validated for clinical and research use
			• Hematuria (>5 RBCs/hpf)	○ Does not capture improving or worsening
			• Proteinuria (>0.5 g/24 hours, new onset or increase of >0.5 g/24 hours)	○ Must wait for labs to score
			• Pyuria (>5 WBCs/hpf, excluding infection)
BILAG [46]	One month	• Category A (severe disease) = ≥2 of the following:	• Blood pressure	✓ Incorporates an element of change
		1. Proteinuria, defined as	• Accelerated hypertension?	✓ Sensitive to small changes
		(a) urinary dipstick increased by 2 or more levels	• Proteinuria (on either dipstick or 24-hour collection)	✓ Can identify if disease improving, stable, or worse
		(b) 24 urinary protein rising from <0.20 to >1 g	○ >1 g/24 hours?	± scoring can be complex (computer program available)
		(c) 24 hour urinary protein rising from >1 g by 100%	○ UPCR >100 mg/mmol?
		(d) newly documented proteinuria of >1 g	• Nephrotic syndrome?	○ Requires formal training
		2. Accelerated hypertension	• Creatinine	○ Developed for research
		3. Deteriorating kidney function, defined as	• Creatinine clearance/GFR	○ Up to 50 minutes to complete
		(a) plasma creatinine >130 μmol/L and having risen to >130%	• Active urinary sediment (>5 WBCs/hfp, >5 RBCs/hpf, or RBC casts)	○ Must wait for labs to score
		(b) creatinine clearance fallen to <67% of previous value	• Histologic evidence of nephritis in the previous 3 months? (excludes sclerosis)
		(c) creatinine clearance <50 mL/min, and last time was >50 mL/min or was not measured
		4. Active urinary sediment
		5. Histological evidence of active nephritis
		• Category B (moderate disease) = one of the following:
		1. Any one of the category A criteria above
		2. Proteinuria
		(a) urinary dipstick which has risen by 1+ or >2+
		(b) 24-hour urinary protein rising from >1 g by >50% but <100%
		3. Plasma creatinine >130 μmol/L and having risen 115%
ECLAM	One month	• 0.5 points for each renal criteria present	• Proteinuria ≥500 mg/day	✓ Derived from a large number of real patients and standardized data
		• 2 extra points added if only kidney involvement	• Urinary casts (RBCs, hemoglobin, granular, tubular, or mixed)	✓ Easy to administer and scor
		• 2 points for evolving manifestations (if any renal symptom new or worse since last evaluation)	• Hematuria (micro- or macro-scopic)	○ Global score will miss changes in severity over time
			• Raised serum creatinine or reduced creatinine clearance
SLAM-R	One month	• Hypertension (diastolic pressure, mm Hg)	No specific renal response criteria but the following components are renal-related:	✓ Evaluates activity and severity
		- 0: <90	• Hypertension	✓ Computerized version available
		- 1: 90-104	• Raised serum creatinine or reduced creatinine clearance	○ Lacks immunologic markers
		- 2: 105-114	• Severity of urine sediment analysis per high-power field	○ Not used in major ongoing clinical trials
		- 3: >115
		- Unknown
		• Serum creatinine or creatinine clearance (% normal)
		- 0: 0.5-1.0 or 80%-100%
		- 1: 1.4-2.0 or 60%-79%
		- 2: 2.1-4.0 or 30%-59%
		- 3: >4.0 or <30%
		- Not recorded
		• Urine sediment
		- 0: normal
		- 1: 6-10 RBCs or WBCs OR 0-3 granular or non-RBC casts OR trace-1+ protein (<500 mg/L 24-hour urine protein)
		- 2: 11-25 RBCs or WBCs OR >3 granular or non-RBC casts OR 2-3+ protein (>500 mg to 3.5 g/L 24-hour urine protein)
		- 3: >25 RBCs or WBCs OR any RBC casts OR 4+ protein (>3.5 g/L 24-hour urine protein)
Disease damage
SLICC/ACR Damage Index [47]	Cumulative damage index	1 point for satisfying GFR or proteinuria	• Estimated or measured GFR <50%	✓ Ability to assess accumulated damage
		3 points if ESKD	• Proteinuria ≥3.5 g/24 hours	✓ Prognostic tool
			• ESKD	○ Recommended for clinical trials to describe population
				○ Accuracy depends on information available

BILAG, British Isles Lupus Assessment Group Index; ECLAM, European Consensus Lupus Activity Measurement; ESKD, end-stage kidney disease; GFR, glomerular filtration rate; hpf, high-power field; RBC, red blood cell; SLAM-R, Systemic Lupus Activity measure-revised; SLEDAI-2 K, systemic lupus erythematosus Disease activity index- 2K; SLICC/ACR, Systemic Lupus International Collaborating Clinics/American College of Rheumatology; UPCR, urinary protein-to-creatinine ratio; WBC, white blood cell.