Risk of complications of ultrasound-guided renal biopsy for adult and pediatric patients with systemic lupus erythematosus

Sun, Yi-Ran; Sun, In-O; Wang, H K; Yang, An-Hang; Tsai, Chang‐Youh; Huang, Cheng‐Hung; Huang, Der-Chen; Lai, Cheng‐chung

doi:10.1177/0961203317751048

Cited by 12 publications

(16 citation statements)

References 26 publications

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“…This strongly suggests that C4d and the C4d/C4 ratio might be useful markers to study the responsiveness to immunosuppressive treatments. Although renal biopsies are the gold standard to diagnose and classify LN ( 24 ), follow-up biopsies after induction of immunosuppressive therapy are not and carry potential risks for bleeding complications ( 25 ). Since C4d levels as well as C4d/C4 ratios were shown to associate strongly with both clinical and histopathological responsiveness, our findings strongly suggest that the simple determination of plasma C4d might at least partially replace invasive biopsies.…”

Section: Discussionmentioning

confidence: 99%

Plasma C4d Correlates With C4d Deposition in Kidneys and With Treatment Response in Lupus Nephritis Patients

et al. 2020

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Objective To examine whether C4d plasma levels correlate with treatment response and C4d kidney deposition in systemic lupus erythematosus (SLE) with lupus nephritis (LN). Methods C4d plasma levels were analyzed by a unique assay specifically detecting C4d arising from complement activation and C4 plasma levels were quantified with competitive ELISA. SLE patients with LN (71) and active SLE patients without LN (22) plus 145 controls were included. For 52 LN patients samples were available both at baseline and after immunosuppressive treatment. C4d kidney deposition was detected using immunohistochemistry in two matching kidney biopsies of 12 LN patients. Results In comparison to population-based controls, plasma C4d levels were significantly increased in SLE patients (0.33 mg/L versus 0.94 mg/ml, p < 0.0001) with significantly higher levels in LN patients (1.02 mg/L) than in non-renal SLE patients (0.57 mg/L, p = 0.004). The C4d/C4 ratio was also significantly higher in LN (11.2) than in non-renal SLE patients (2.5, p = 0.0002). According to ROC curve analysis, C4d was found to be an accurate marker to discriminate LN from non-renal SLE patients ( p = 0.004). The C4d/C4 ratio displayed even higher specificity, sensitivity and overall accuracy as marker for LN than C4d and C4 alone. At baseline, C4d levels correlated significantly with urine-albumin to creatinine ratio ( r s = 0.43, p = 0.011) and with renal activity index ( r s = 0.37, p = 0.002). Immunohistochemical staining showed glomerular deposits of C4d in kidney biopsies, which strikingly correlated with plasma C4d levels ( r s = 0.7, p = 0.0002). Plasma C4d declined significantly after treatment in patients that experienced favorable clinical and histopathological response ( p < 0.0001), while levels remained mainly unchanged in non-responders. Conclusion Plasma C4d discriminates LN from active non-renal SLE, correlates with C4d kidney deposits and appears valuable in monitoring responsiveness to various treatments. The C4d/C4 ratio might be superior to C4d alone.

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Section: Discussionmentioning

confidence: 99%

Plasma C4d Correlates With C4d Deposition in Kidneys and With Treatment Response in Lupus Nephritis Patients

et al. 2020

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“…Class II LN was the most common pathology (53%, 7/13) in patients with relapsing proteinuria, of whom none had severe interstitial fibrosis and/or tubular atrophy. Considering that the goal of early diagnosis of LN is preserving renal function without irreversible renal damage 12 and that kidney biopsy entails a notable risk of complications, 13,14 our present study suggests that performing a kidney biopsy at the time of the first onset of proteinuria could be delayed in certain SLE patients with proteinuria. In particular, it is likely that biopsy may not be essential for patients showing a significant improvement in proteinuria after treatment with corticosteroid for the management of systemic SLE activity other than kidney involvement.…”

Section: Discussionmentioning

confidence: 87%

Renal outcomes of transient proteinuria in patients with systemic lupus erythematosus treated with corticosteroid therapy alone

Kim

Ahn

et al. 2022

Lupus

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Objectives To examine the long-term renal outcomes of systemic lupus erythematosus (SLE) patients with transient proteinuria. Methods The medical records of SLE patients who showed improvement in proteinuria (urine protein/creatinine ratio < 500 mg/g) after receiving corticosteroid therapy without immunosuppressants were reviewed. Results A total of 38 patients (mean creatinine: 0.74 ± 0.33 mg/dl) showed an improvement of proteinuria (1361 ± 1053 mg/g to 289 ± 125 mg/g) after receiving corticosteroid therapy alone for a median of 25 days (IQR, 10–55). After follow-up (median, 23 months [IQR, 15–121]), 25 (65%) patients maintained the resolution of proteinuria without renal dysfunction. The remaining 13 (34%) patients experienced a relapse of proteinuria during a median follow-up of 13.9 months from baseline (IQR, 1.6–25). There was no significant difference in the baseline laboratory data according to the occurrence of proteinuria relapse, but longer SLE disease duration at baseline was associated with the risk of proteinuria relapse (HR, 1.007; p = 0.033). Of the patients who underwent renal biopsy with proteinuria relapse, class II (53%) lupus nephritis was the most common pathology. None progressed to end-stage renal disease during an additional long-term further follow-up of median 33 months (IQR, 22–49) after proteinuria relapse. Conclusion Two-thirds of SLE patients who showed improvement in proteinuria after corticosteroid alone maintained the non-proteinuric state without renal dysfunction. Thus, performing a kidney biopsy at the first onset of proteinuria could be delayed in patients who show an improvement in proteinuria after treatment with corticosteroids.

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“…repeated biopsies, for native or transplant kidneys. To our knowledge, only one study (22) has examined risk factors for complications in subsequent native kidney biopsies. The aim of this previous study by Sun et al.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of this previous study by Sun et al. (22) was to identify the risk of biopsy complications in adult and pediatric patients with systemic lupus erythematosus (SLE). In this patient group, risk factors for biopsy complications in initial biopsies were impaired kidney function, prolonged prothrombin time (PT), thrombocytopenia, and age < 18 years, whereas in subsequent biopsies thrombocytopenia, prolonged PT and impaired kidney function were found to be risk factors for complications.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for biopsy complications in initial versus subsequent biopsies in native and transplant kidneys

et al. 2020

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Background Few studies exist about risk factors for complications in subsequent biopsies. Purpose To explore risk factors for complications in initial versus subsequent biopsies in native and transplant kidneys, which may predict biopsy complications. Material and Methods In a multicenter study, 2830 native kidney biopsies (4.3% subsequent) were analyzed for major complications (1251 of these were also analyzed for minor) and 667 transplant kidney biopsies (29% subsequent) were analyzed for major and minor complications. No death or nephrectomy were described. Fisher’s exact test, Student’s t-test, chi-square analyses, and univariate and multiple binary logistic regression analyses were employed; P < 0.05 was considered significant. Results In initial native kidney biopsies, the frequency of major complications was higher in women compared to men (odds ratio 1.6, 95% confidence interval 1.1–2.2), in younger patients (50 vs. 54 years, P = 0.007), and in patients with lower weight (78 vs. 82 kg, P = 0.005). In subsequent native kidney biopsies, patients with major complications had a higher systolic blood pressure (145 vs. 132 mmHg, P = 0.03). In initial transplant kidney biopsies, biopsies with major complications had less glomeruli in the biopsy (17 vs. 24, P = 0.046). In subsequent transplant kidney biopsies, patients with major complications had a higher mean arterial pressure (112 vs. 98 mmHg, P = 0.002). In subsequent native kidney biopsies, there was a higher number of SLE-nephritis (12% vs. 4.6%, P = 0.001) compared to initial biopsies. Conclusion The different types of risk factors for complications in initial versus subsequent renal biopsies could be important for the clinicians to improve patients’ safety.

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Risk of complications of ultrasound-guided renal biopsy for adult and pediatric patients with systemic lupus erythematosus

Cited by 12 publications

References 26 publications

Plasma C4d Correlates With C4d Deposition in Kidneys and With Treatment Response in Lupus Nephritis Patients

Plasma C4d Correlates With C4d Deposition in Kidneys and With Treatment Response in Lupus Nephritis Patients

Renal outcomes of transient proteinuria in patients with systemic lupus erythematosus treated with corticosteroid therapy alone

Risk factors for biopsy complications in initial versus subsequent biopsies in native and transplant kidneys

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