Lupus & antiphospholipid syndrome
The Renal Activity Index for Lupus Identifies Active Renal Disease and Treatment Response in Adult Patients With Systemic Lupus Erythematosus and Lupus Nephritis
Authors' conclusion
The RAIL identifies active LN and longitudinally differentiates treatment response in adults with LN.
Study context
- Population
- Adults with active systemic lupus erythematosus (SLE) with or without active lupus nephritis (LN)
- Participants
- 128 vs 48
- Comparison
- Active LN vs active nonrenal SLE; Renal Activity Index for Lupus (RAIL) score changes in responders vs nonresponders
- Active LNn = 128
- Active SLEn = 48reference
- Outcome
- Ability of RAIL to discriminate active LN and differentiate LN treatment response
Methodological detailssecondary analysis of the TULIP-LN and TULIP-1 trials, urine biomarkers at baseline and weeks 12 and 24 (TULIP-LN only)
- Secondary analysis of the TULIP-LN and TULIP-1 trials
- Urine biomarkers at baseline and weeks 12 and 24 (TULIP-LN only)
Performance
As reported in the abstract
RAIL score at baseline
Active LN
5.59
median · IQR 4.31–6.47
Active SLE
3.57
median · IQR 2.78–4.47
P < 0.001
- Median concentrations of RAIL biomarkers significantly higher in active LN vs SLE control
- P ≤ 0.02
Further findings
Median
| Outcome | CRR | Non-response |
|---|---|---|
| Median change in RAIL score, CRR vs non-response · week 12 | −1.3 (IQR −3.64–-0.21) | −0.39 |
| Median change in RAIL score, CRR vs non-response · week 24 | −2.30 (IQR −3.63–-1.03) | −0.88 (IQR −2.20–0.33) |
Change in RAIL score from baseline, responders (partial renal response (PRR), complete renal response (CRR), UPCR50) vs nonresponders · weeks 12 and 24
- Changes significantly differed, with lower scores in responders (PRR, CRR, UPCR50)
- all P < 0.0006
- Patients with CRR at weeks 12 and 24
- 25 and 31
- Patients with PRR at weeks 12 and 24
- 39 and 54
- Patients with UPCR50 at weeks 12 and 24
- 41 and 63
Original publication
The Renal Activity Index for Lupus Identifies Active Renal Disease and Treatment Response in Adult Patients With Systemic Lupus Erythematosus and Lupus Nephritis. Arthritis Care Res (Hoboken). Published 23 February 2026. doi:10.
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