Recognition of Information in Renal Biopsies of Patients with Lupus Nephritis

Abstract

To evaluate the informational value of renal biopsy in nephritis of systemic lupus erythematosus, we selected the records of 30 patients who had a renal biopsy done and also had a known clinical outcome. Detailed case histories were prepared, and three distinct randomly chosen cases were given to 197 academic rheumatologists. The rheumatologists estimated the probability of future clinical events (worsened serum creatinine, worsened urine protein, renal death, and aggressive therapy) at 3 and 12 months after the biopsy. Biopsy results were given in detail, and probability estimates were made of the same clinical events using the additional information. The accuracy of each probability estimate was measured using a scoring function that depends on the estimates and the actual outcomes. Knowledge of the renal biopsy failed to improve predictive accuracy scores of estimates of future serum creatinine levels, urine protein levels, and renal death at 3 and 12 months (p less than 0.0001), and for estimates of the probability of the use of aggressive therapy at 12 months (p less than 0.007). The renal biopsy information improved only the accuracy of predictions concerning the use of aggressive therapy at 3 months (p less than or equal to 0.0003). Knowledge of the renal biopsy results failed to add important prognostic information about the future course of treated lupus nephritis to information already obtained from history, physical examination, and laboratory tests.

Prognostic value of renal biopsy and clinical variables in patients with lupus nephritis and normal serum creatinine

“…This policy may introduce a bias which may weaken the association between a poor renal outcome and the renal pathology, but no false associations may be introduced. Furthermore, it has been shown that renal biopsy results failed to add prognostic information about the future course of treated lupus nephritis to clinical information already obtained (17). With this reservation in mind we have analysed the in¯uence of demographic, clinical and renal biopsy data on the development of CRI and ESRD.…”

Observer Agreement in the Scoring of the Activity and Chronicity Indexes of Lupus Nephritis

“…Thus, the activity and chronicitiy indexes are useful to distinguish between patients with high versus low risk to develop end-stage renal failure. In fact, in a study assessing the impact of renal biopsy in the prediction of outcome, prognosis and management of LN, Whiting-O' Keefe et al [17] presented a questionnaire with several cases of LN to 197 rheumatologists; the results showed that renal biopsy was useful to predict which of the patients received aggressive treatment in the first 3 months of therapy. For this reason, we investigated the extent of agreement in the ability to score the activity and chronicity indexes of LN among three experienced pathologists.…”

Prognosis in systemic lupus erythematosus

“…This is likely for a number of reasons. Firstly, while clinicians with considerable experience specifically in the management of lupus nephritis are expert at predicting both short-term and long-term outcome without recourse to renal biopsy data [16], this may not be true for all physicians [90]. Secondly, performing a renal biopsy frequently galvanizes an appropriate decision on treatment.…”