Background:The pathological class of lupus nephritis (LN) may change to a different class during the course of the disease. Renal biopsy is repeated is repeated in many patients during a flare but there is there is no agreement about systematically recommending them because proliferative lesions on their original biopsy rarely switch to a pure nonproliferative nephritis during a flare. However, renal rebiopsy may be useful in some cases to make appropriate adjustments or changes of treatment.Objectives:To analyze the impact of renal rebiopsy on the therapeutic approach in patients with previous histological diagnosis of LN who experience a worsening in the clinical parameters of renal involvement.Methods:Retrospective study of patients with histological diagnosis of NL subjected to at least one renal biopsy. We studied the demographic, clinical, histopathological variables of the first and subsequent renal biopsies, received treatment and the therapeutic modifications in relation to the result of the rebiopsies.Results:We analyzed 35 patients diagnosed with LN between 1978 and 2017. 9 of them had been rebiopsied at least on one occasion and made a total of 11 rebiopsies (7 patients with a rebiopsy and 2 patients with 2 rebiopsies). All patients were female and Caucasian, except for a Hispanic woman, with a mean age at the time of the rebiopsy of 31 ± 12 years (14-55). The mean serum creatinine at the time of the first re-biopsy was 0.8 ± 0.17 mg/dl (0.5-1.06) and in the second, 1.18 ± 0.05 mg/dl (1.15-1.23). The fundamental indication for the rebiopsy was the increase in proteinuria, up to non-nephrotic range in 64% of the patients and within the nephrotic range in 36%. In comparison with the previous biopsy, 3 of the rebiopsies (27%) showed evolution from a non-proliferative to a proliferative form (from II to III, from II to IV and from V to V + IV). 4 of the rebiopsies (36%) started from a proliferative class and changed class but within these forms (3 from IV to III and and 1 from III to IV). The remaining 4 rebiopsies (27%) showed no change in the histological type. Regarding the baseline biopsy, we observed a decrease in the index of activity of the rebiopsies (5.4 ± 2.2 vs 3.4 ± 2.5, p = 0.017) and an increase in the chronicity index (0.8 ± 0.7 vs 2.9 ± 3.2, p = 0.027). In all cases, therapeutic modifications were carried out. In 9 cases (82%) the immunosuppression was increased and in two of them (18%) it was decreased.Conclusion:The repetition of renal biopsy in cases of LN with clinical data of renal deterioration is relevant. The change of histological class and the evolution of activity and chronicity indexes support the decision to increase immunosuppression and are fundamental to diminish it.References[1] Narváez J, et al. The value of repeat biopsy in lupus nephritis flares. Medicine (Baltimore). 2017;96:e7099.Disclosure of Interests:None declared
BackgroundIn patients with Elderly-onset Rheumatoid Arthritis (EORA) has been described a clinical debut mimicking polymyalgia rheumatica with rhizomelic pseudopolyarthritis, in contrast with the classical profile of patients with Rheumatoid Arthritis similar to younger patients. We compare in our study these two profiles of the disease.ObjectivesTo describe and compare the differences according to clinical debut, serological positivity and its implications in terms of treatment and prognostic factors in patients with Elderly-onset Rheumatoid Arthritis (EORA).MethodsPatients with a diagnosis of RA over 65 years of age according to ACR/EULAR 2010 criteria were included. A database was created including the age of onset, the presence of polymyalgia-like symptoms (rhizomelic pseudopolyarthritis), the positivity of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), elevation of acute phase reactants (APR), the presence of erosions and the treatment required. Finally, data was analyzed according to clinical debut, serological positivity and prognostic factors.Results83 patients diagnosed of EORA were included, with an average age of 73.8 years. 71.25% had positive RF (58.75% high titers) and 62.5% had positive ACPA (52.3% high titers). 24/83 patients (29%) debuted with a polymyalgia-like symptoms. 47.5% had persistent APR elevation during follow-up. Regarding treatment, 15% were treated only with corticosteroids, 81.5% required treatment with DMARDs and 15% were receiving biological treatment. 42/83 patients (50%) had erosions on plain X-rays. Of those patients with a polymyalgia-like profile, 52.2% (43/83) had positive RF but most of them had low titers (61%). On the other hand, patients without polymyalgia-like symptoms had positive RF in 78% of the cases and most of them at high titers (66%, p = 0.01). In the first group there was less positivity for ACPAs (26%, p = 0.00004) and half of them had low titers. Erosions were observed in only 30% of the patients with polymyalgia-like symptoms, while those without this profile had more erosions (58%, p = 0.02) and higher APR (50%, p = 0.026). Regarding treatment, in the group with polymyalgia-like symptoms only 34% were treated with corticosteroids, 65% required DMARDs and no patients had received biological treatment, whereas in the non-polymyalgic group, 88% required DMARDs and 21% required biologics (p = 0.01 for both results). Analyzing patients with positive RF and ACPAs at high titers, 93% received treatment with DMARDs and 24% required biological treatment. 65% had persistent elevation of APR and 48% presented erosions on plain X- rays. Only 2 patients with positive RF and ACPAs at high titers debuted with a polymyalgia-like symptoms.ConclusionPatients with EORA with polymyalgia-like symptoms tend to have less erosions and a higher prevalence of negative RF and ACPA or at low titers. These patients usually require less DMARDs and biological treatments to control the disease unlike patients with non-polymyalgia symptoms. On the other hand, pat...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.