Clinico-pathological features of repeat renal biopsies in patients with lupus nephritis at Groote Schuur Hospital, Cape Town

Abstract

Background Repeat renal biopsies in patients with lupus nephritis are usually done to guide treatment or to establish disease chronicity. Their value is not clear from available literature. There are also no available data in Africa to guide clinicians. Methods This was a retrospective study of patients undergoing a repeat renal biopsy between January 2003 and December 2014 from a single centre in Cape Town, South Africa. Relevant demographic, clinical and histological records of patients with repeat renal biopsies were documented. Comparison of data from first and second renal biopsy was performed. Results Forty-four patients had at least two biopsies done during the study period. Most patients were females (81.8%). The mean biopsy interval was 2.8 ± 1.8 (range 0.38–9.4) years. Proteinuria was the main indication for the repeat biopsy (36.1%). The glomerular filtration rate and proteinuria worsened between the two biopsies ( p = 0.001 and 0.019, respectively) suggesting disease progression. Most patients (65.4%) with a non-proliferative class of lupus nephritis at first biopsy progressed into a proliferative class, whereas patients with initial proliferative lupus nephritis at first biopsy (77.8%) remained as proliferative at repeat biopsy. Treatment was changed in 85% of patients at second biopsy. Conclusion Repeat renal biopsies in patients with lupus nephritis presents a useful means of assessing disease progression and provides guidance regarding modification of treatment. More studies are, however, required to evaluate the value of repeat biopsies and perhaps the need for protocol renal biopsies in patients with lupus nephritis.

Systemic lupus erythematosus, lupus nephritis and end-stage renal disease: a pragmatic review mapping disease severity and progression

“…The majority of studies suggested that patients with class IV had the worst prognosis, and class IV was consistently the most frequent histopathological class of LN, at both first and repeat biopsies. [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] However, it should be noted that there is the chance of selection bias in these studies due to the type of patients who undergo biopsy. A renal biopsy is recommended for diagnosis of LN.…”

“… ISN/RPS: International Society of Nephrology/Renal Pathology Society; LN: lupus nephritis; WHO: World Health Organization. (a)) and at repeat biopsy 24 , 25 , 28 , 32 , 34 , 35 ( Figure 2 (b)). The classes reported least frequently at initial biopsy were class I and class VI ( Figure 2 (a)).…”

“…Class IV nephritis (diffuse proliferative glomerulonephritis) was the most frequently reported LN classification at initial biopsy [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] (Figure 2(a)) and at repeat biopsy 24,25,28,32,34,35 (Figure 2(b)). The classes reported least frequently at initial biopsy were class I and class VI (Figure 2(a)).…”

“…38 Histological transformations were more common from non-proliferative lesions (class II and class V) compared with proliferative lesions (class III and class IV). 28,32,[38][39][40]…”

Stellenwert der Nierenbiopsie bei Lupusnephritis

“…Wenn aufgrund eines renaler Schub, Kreatininanstieg oder Zunahme der Proteinurie eine wiederholte Nierenbiopsie durchgeführt wurde, zeigte sich bei einem meist größeren Zeitabstand von 2-6 Jahren bei 63-65 % ein Übergang von nicht-proliferativer LN (Klasse I und II) auf eine proliferative LN, bei 40 % ein Übergang von nicht-proliferativer LN Klasse V auf eine proliferative LN, während bei 8-28 % eine Transition von proliferativ auf nicht-proliferativ zu verzeichnen war, jedoch häufiger von Klasse III und IV in Klasse V oder VI als in Klasse I und II [39][40][41]. Ein Kreatininanstieg war meist mit einer zunehmenden interstitiellen Fibrose und tubulären Atrophie assoziiert [40].…”