A S Alvarado1, A Malvar2, B Lococo2, V Alberton3, F Toniolo4, H N Nagaraja5, B H Rovin6. 1. Nephrology Division, The Ohio State University Wexner Medical Center, Ohio, USA. 2. Nephrology Division, Hospital Fernandez, Buenos Aires, Argentina. 3. Pathology Department, Hospital Fernandez, Buenos Aires, Argentina. 4. Centro de Diagnostico Patologico, Buenos Aires, Argentina. 5. The Ohio State University College of Public Health, Ohio, USA. 6. Nephrology Division, The Ohio State University Wexner Medical Center, Ohio, USA rovin.1@osu.edu.
Abstract
BACKGROUND: The duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1-2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat kidney biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission. METHODS: The practice in a large Buenos Aires nephrology unit is to repeat a kidney biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease. RESULTS: Despite normalization of serum creatinine and reduction of proteinuria to <500 mg/d, 30% of patients still had significant activity at the last biopsy. Conversely, 60% of patients with ongoing proteinuria (500-1000 mg/d), or stable but abnormal serum creatinine, had no activity by biopsy. Univariate association analyses demonstrated that improvement in the activity index (AI) of the last biopsy was associated with choice of induction therapy (cyclophosphamide or mycophenolate), improvement in serum creatinine over the first six months of treatment, and improvement in complement component C4. By multivariate regression analyses, two AI prediction models emerged. Cyclophosphamide plus change in serum creatinine or cyclophosphamide plus change in C4 accounted for 50% of the improvement in AI. CONCLUSION: These data suggest that a repeat biopsy may be useful in making the decision to withdraw or continue maintenance immunosuppression.
BACKGROUND: The duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1-2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat kidney biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission. METHODS: The practice in a large Buenos Aires nephrology unit is to repeat a kidney biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease. RESULTS: Despite normalization of serum creatinine and reduction of proteinuria to <500 mg/d, 30% of patients still had significant activity at the last biopsy. Conversely, 60% of patients with ongoing proteinuria (500-1000 mg/d), or stable but abnormal serum creatinine, had no activity by biopsy. Univariate association analyses demonstrated that improvement in the activity index (AI) of the last biopsy was associated with choice of induction therapy (cyclophosphamide or mycophenolate), improvement in serum creatinine over the first six months of treatment, and improvement in complement component C4. By multivariate regression analyses, two AI prediction models emerged. Cyclophosphamide plus change in serum creatinine or cyclophosphamide plus change in C4 accounted for 50% of the improvement in AI. CONCLUSION: These data suggest that a repeat biopsy may be useful in making the decision to withdraw or continue maintenance immunosuppression.
Authors: Jessica L Turnier; Hermine I Brunner; Michael Bennett; Ashwaq Aleed; Gaurav Gulati; Wendy D Haffey; Sherry Thornton; Michael Wagner; Prasad Devarajan; David Witte; Kenneth D Greis; Bruce Aronow Journal: Rheumatology (Oxford) Date: 2019-02-01 Impact factor: 7.580
Authors: Hermine I Brunner; Michael R Bennett; Gaurav Gulati; Khalid Abulaban; Marisa S Klein-Gitelman; Stacy P Ardoin; Lori B Tucker; Kelly A Rouster-Stevens; David Witte; Jun Ying; Prasad Devarajan Journal: J Rheumatol Date: 2017-06-15 Impact factor: 4.666
Authors: G Gulati; M R Bennett; K Abulaban; H Song; X Zhang; Q Ma; S V Brodsky; T Nadasdy; C Haffner; K Wiley; S P Ardoin; P Devarajan; J Ying; B H Rovin; H I Brunner Journal: Lupus Date: 2016-12-19 Impact factor: 2.911
Authors: Samir V Parikh; Ana Malvar; Huijuan Song; Valeria Alberton; Bruno Lococo; Jay Vance; Jianying Zhang; Lianbo Yu; Dan Birmingham; Brad H Rovin Journal: Transl Res Date: 2016-11-01 Impact factor: 7.012
Authors: Juan M Mejia-Vilet; Xiaolan L Zhang; Cristino Cruz; Mayra L Cano-Verduzco; John P Shapiro; Haikady N Nagaraja; Luis E Morales-Buenrostro; Brad H Rovin Journal: J Am Soc Nephrol Date: 2020-04-16 Impact factor: 10.121