The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement.
ABSTRACT The goal of this study is to determine the value of early renal biopsy as a therapeutic guide in systemic lupus erythematosus (SLE) patients presenting with renal involvement.
We retrospectively analyzed renal biopsies findings in SLE patients between January 2000 and December 2009 encountered at a medical center in Taiwan. An additional criterion for inclusion in this study was kidney biopsy done within 3 months of the first detection of sign(s) of renal disease.
There were 131 patients enrolled in this study. In patients presenting with acute renal failure, 91% of patients had proliferative lupus nephritis (Class IV, mixed Class V+III) and 9% had non-proliferative lupus nephropathy (pure Class V). In patients presenting with nephrotic range proteinuria, proliferative lupus nephritis (Class III, IV, mixed Class V+III) and non-proliferative lupus nephropathy (Class II, pure Class V) accounted for 55% and 36% of patients, respectively; and 9% had non-lupus nephropathy. In this group, except that elevated anti-double-stranded DNA antibody levels were more common in proliferative lupus nephritis (p = 0.043), no clinical findings could predict the renal morphology. In patients presenting with subnephrotic proteinuria, 49% of patients had proliferative lupus nephritis (Class III, IV, mixed Class V+III) and 51% had non-proliferative lupus nephropathy (Class II, pure Class V), and decreased C4 levels were more common in patients with proliferative lupus nephritis (p = 0.031). In patients presenting with isolated hematuria, all were not active forms of nephropathy. Immunosuppressive therapy was intensified because of biopsy findings in 29% of patients presenting with acute renal failure, 43% with nephrotic range proteinuria, and 53% with sub-nephrotic proteinuria.
Our data suggested that similar clinical renal manifestations may be observed despite very different classes of lupus nephritis. Clinicians tended to wait for histological identification of severe lupus nephritis before initiating potential harmful treatment with aggressive immunosuppressive therapy. Therefore, in SLE patients with clinical sign(s) of renal disease, early renal biopsy may be helpful in planning treatment.
Article: Lupus Nephritis: Is the Kidney Biopsy Currently Necessary in the Management of Lupus Nephritis?[show abstract] [hide abstract]
ABSTRACT: Most patients with SLE develop kidney disease related to this systemic underlying disease process. Lupus nephritis is an important cause of morbidity and even mortality in patients with systemic lupus erythematosus. Lupus nephritis has diverse morphologic manifestations with varying clinical presentations and consequences. The pathogeneses involve immune complexes, which can deposit anywhere in the kidney, and other mechanisms, including endothelial injury, podocytopathy, and tubulointerstitial injury. Treatment and prognosis accordingly range from excellent even with only observation with minimal mesangial deposits, to kidney failure despite aggressive immunosuppression in patients with severe proliferative disease. Renal biopsy plays a crucial role in the diagnosis of the specific form of lupus nephritis in any patient. However, the role of the renal biopsy in prediction of outcome, treatment, and prognosis has been controversial. We will review the current classification of lupus nephritis and the value of renal biopsy in the management of these patients.Clinical Journal of the American Society of Nephrology 09/2012; · 5.23 Impact Factor