Repeat Renal Biopsy in Lupus Nephritis: A Change in Histological Pattern Is Common

Background: The role of longitudinal change in sequential renal biopsies of lupus nephritis (LN) patient remains elusive. Methods: Clinical and pathological documents of 156 LN patients with repeat renal biopsies (412 times) were collected from a database. Results: The percent of transformation of the biopsy class from reference biopsies to repeat biopsies was 75%. For the reference biopsies that showed pure proliferative, pure membranous, and mixed nephritis, the histological pattern in the repeat biopsies changed in 57.8, 50.0, and 60.4%, respectively. As compared to reference biopsy, repeat biopsy had a higher degree of tubulointerstitial scarring (p < 0.001), chronicity index (p < 0.001) and serum creatinine (p < 0.001). In addition, baseline serum creatinine was significantly lower (p = 0.004), and the time lapse between the two biopsies was significantly longer (p < 0.001) amongst patients who had a change in the histological pattern upon repeat renal biopsy than those whose histological pattern remained the same. Conclusion: The present study suggests that a change in the histological class of LN is common in systemic lupus erythematosus patients with lupus flare, and the histology during disease flare could not be predicted by baseline clinical, biochemical, or pathological parameters. Our results indicate that when there is lupus flare with renal involvement, repeat renal biopsy is often necessary to guide the treatment.

[1]  S Quaglini,et al.  Clinical and prognostic value of serial renal biopsies in lupus nephritis. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[2]  D. Boumpas,et al.  Lupus nephritis flares , 2005, Lupus.

[3]  B. Kotzin Systemic Lupus Erythematosus , 1996, Cell.

[4]  L. Pasquier,et al.  Orphanet Journal of Rare Diseases , 2006 .

[5]  C. Szeto,et al.  Is combination rituximab with cyclophosphamide better than rituximab alone in the treatment of lupus nephritis? , 2009, Rheumatology.

[6]  C. Ponticelli,et al.  Flares in lupus nephritis: Incidence, impact on renal survival and management , 1998, Lupus.

[7]  J. Esdaile,et al.  The pathogenesis and prognosis of lupus nephritis: information from repeat renal biopsy. , 1993, Seminars in arthritis and rheumatism.

[8]  Lee Hebert,et al.  The classification of glomerulonephritis in systemic lupus erythematosus revisited. , 2004, Kidney international.

[9]  T. Chan,et al.  Efficacy of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis , 2000 .

[10]  J. Grande,et al.  Renal biopsy in lupus nephritis , 1998, Lupus.

[11]  J. Klippel,et al.  Prognostic factors in lupus nephritis. Contribution of renal histologic data. , 1983, The American journal of medicine.

[12]  I. Bajema,et al.  The clinical relevance of a repeat biopsy in lupus nephritis flares. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[13]  A. Levey,et al.  A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation , 1999, Annals of Internal Medicine.

[14]  J. Forslid,et al.  Repeated renal biopsy in proliferative lupus nephritis--predictive role of serum C1q and albuminuria. , 2002, The Journal of rheumatology.

[15]  D. Levison,et al.  Renal biopsy , 2005, The Histochemical Journal.

[16]  C. Lau,et al.  Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group. , 2000, The New England journal of medicine.

[17]  B. Myones,et al.  Outcomes of children with proliferative lupus nephritis: the role of protocol renal biopsy , 2007, Pediatric Nephrology.

[18]  M. Hochberg,et al.  Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. , 1997, Arthritis and rheumatism.

[19]  G. Appel,et al.  RENAL INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): A Study of 56 Patients Emphasizing Histologic Classification , 1978, Medicine.

[20]  D. Sackett,et al.  Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. , 1992, Arthritis and rheumatism.

[21]  M. Petri,et al.  Kidney biopsy in lupus nephritis: look before you leap. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  D. Gladman,et al.  Serial renal biopsy in systemic lupus erythematosus. , 2000, The Journal of rheumatology.

[23]  B. Kasinath,et al.  Course of renal pathology in patients with systemic lupus erythematosus. , 1984, The American journal of medicine.

[24]  D. Baldwin,et al.  Lupus nephritis: Clinical course as related to morphologic forms and their transitions , 1977 .

[25]  V. Strand,et al.  Relationship between anti-double-stranded DNA antibodies and exacerbation of renal disease in patients with systemic lupus erythematosus. , 2005, Arthritis and rheumatism.

[26]  A. Ciampi,et al.  The longterm prognosis of lupus nephritis: the impact of disease activity. , 1993, Journal of Rheumatology.