OBJECTIVE: The clinical impact of repeat renal biopsies in patients with lupus nephritis (LN) is still debatable. The aim of this retrospective analysis was to assess whether repeat renal biopsy is a reliable tool in guiding therapeutic decisions. METHODS: Laboratory and histological parameters and therapeutic changes in 35 patients with LN and repeat renal biopsies were retrospectively analyzed. Biopsies were performed in the presence of clinical evidence of an active glomerular disease. Biopsy specimens were retrospectively re-assessed by two renal pathologists and were compared according to the last International Society of Nephrology/ Renal Pathology Society classification. RESULTS: Thirty-five patients had two, 13 had three, 5 had four, 4 had five, and 1 had six renal biopsies. Fifty-eight comparisons of renal biopsies were made. Median times between the first and second, second and third, third and fourth, and fourth and fifth biopsies were 31, 27, 34, and 28 months, respectively. The mean activity indices from the first to the fifth biopsy were 8.7, 6.6, 7.8, 9.4, and 4.7, whereas the mean chronicity indices were 1.7, 2.3, 4.3, 5.2, and 7.7, respectively. Conversion was observed in 65.5% of cases with the most frequent (21%) being between classes III and IV. Conversion to a more severe type of nephritis occurred in 19% of cases. There was no correlation of laboratory parameters to the type of nephritis upon conversion. In 79% of cases, immunosuppressive therapy was modified after repeat biopsy. CONCLUSION: Repeat biopsy is a reliable tool for monitoring the activity and chronicity status of LN and for tailoring immunosuppressive therapy to the needs of the patient, especially late in the course of the disease.
OBJECTIVE: The clinical impact of repeat renal biopsies in patients with lupus nephritis (LN) is still debatable. The aim of this retrospective analysis was to assess whether repeat renal biopsy is a reliable tool in guiding therapeutic decisions. METHODS: Laboratory and histological parameters and therapeutic changes in 35 patients with LN and repeat renal biopsies were retrospectively analyzed. Biopsies were performed in the presence of clinical evidence of an active glomerular disease. Biopsy specimens were retrospectively re-assessed by two renal pathologists and were compared according to the last International Society of Nephrology/ Renal Pathology Society classification. RESULTS: Thirty-five patients had two, 13 had three, 5 had four, 4 had five, and 1 had six renal biopsies. Fifty-eight comparisons of renal biopsies were made. Median times between the first and second, second and third, third and fourth, and fourth and fifth biopsies were 31, 27, 34, and 28 months, respectively. The mean activity indices from the first to the fifth biopsy were 8.7, 6.6, 7.8, 9.4, and 4.7, whereas the mean chronicity indices were 1.7, 2.3, 4.3, 5.2, and 7.7, respectively. Conversion was observed in 65.5% of cases with the most frequent (21%) being between classes III and IV. Conversion to a more severe type of nephritis occurred in 19% of cases. There was no correlation of laboratory parameters to the type of nephritis upon conversion. In 79% of cases, immunosuppressive therapy was modified after repeat biopsy. CONCLUSION: Repeat biopsy is a reliable tool for monitoring the activity and chronicity status of LN and for tailoring immunosuppressive therapy to the needs of the patient, especially late in the course of the disease.
Authors: Bevra H Hahn; Maureen A McMahon; Alan Wilkinson; W Dean Wallace; David I Daikh; John D Fitzgerald; George A Karpouzas; Joan T Merrill; Daniel J Wallace; Jinoos Yazdany; Rosalind Ramsey-Goldman; Karandeep Singh; Mazdak Khalighi; Soo-In Choi; Maneesh Gogia; Suzanne Kafaja; Mohammad Kamgar; Christine Lau; William J Martin; Sefali Parikh; Justin Peng; Anjay Rastogi; Weiling Chen; Jennifer M Grossman Journal: Arthritis Care Res (Hoboken) Date: 2012-06 Impact factor: 4.794
Authors: David Askenazi; Barry Myones; Ankur Kamdar; Robert Warren; Maria Perez; Marietta De Guzman; Anna Minta; M John Hicks; Arundhati Kale Journal: Pediatr Nephrol Date: 2007-03-03 Impact factor: 3.714
Authors: John N Boletis; Smaragde Marinaki; Chryssanthe Skalioti; Sofia S Lionaki; Aliki Iniotaki; Petros P Sfikakis Journal: Nephrol Dial Transplant Date: 2009-01-29 Impact factor: 5.992
Authors: Gabriëlle M N Daleboudt; Ingeborg M Bajema; Natascha N T Goemaere; Jaap M van Laar; Jan A Bruijn; Stefan P Berger Journal: Nephrol Dial Transplant Date: 2009-07-21 Impact factor: 5.992