Strategy for second kidney biopsy in patients with lupus nephritis

Alsuwaida, Abdulkareem; Husain, Sufia; Alghonaim, Mohammed; Aloudah, Noura; Al-Wakeel, Jamal; Ullah, Anhar; Kfoury, Hala

doi:10.1093/ndt/gfr517

Cited by 70 publications

(75 citation statements)

References 23 publications

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“…Increasing chronic damage on the postinduction biopsy also predicted long-term renal outcomes in some studies (57,58). The National Institutes of Health (NIH) activity and chronicity indices (64) were measured in repeat biopsies 12-18 months after starting treatment, while patients were on maintenance immunosuppression (65). After 10 years of follow-up, the probability of doubling serum creatinine was about 56% for patients whose second biopsy had persistent activity (an activity index .2), compared with 20% for patients who had an activity index #2 (P,0.001).…”

Section: The Kidney Biopsy In Lnmentioning

confidence: 99%

Update on Lupus Nephritis

Almaani

Meara

Rovin

2016

CJASN

706

535

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SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients. This review highlights recent updates in our understanding of disease epidemiology, genetics, pathogenesis, and treatment in an effort to establish a framework for lupus nephritis management that is patient-specific and oriented toward maintaining long-term kidney function in patients with lupus.

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Section: The Kidney Biopsy In Lnmentioning

confidence: 99%

Update on Lupus Nephritis

Almaani

Meara

Rovin

2016

CJASN

706

535

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“…The presence of crescents in more than 30% of glomeruli and a chronicity index >5 at repeat renal biopsy were independently associated with the doubling of serum creatinine at 10 years [78]. Alsuwaida et al [75] performed a second renal biopsy after 12e18 months from baseline in 77 patients followed for 8.7 years. The 10 year renal survival rate was 100% for patients with an activity index of 0, it was 80% for those with an activity index of 1 or 2 and 44% for patients with an activity index >2 at s renal biopsy.…”

Section: How Often Should Renal Biopsy Be Performed?mentioning

confidence: 99%

Lupus nephritis: When and how often to biopsy and what does it mean?

Moroni

Depetri

Ponticelli

2016

Journal of Autoimmunity

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“…Lupus nephritis is mostly diagnosed in women in their thirties and is the primary cause of systemic disease with secondary renal involvement [1]. Available clinical endpoints in LN to assess response to treatment have limited utility, as they may not directly reflect renal histopathological features that have been associated with poor prognosis [2]. Histopathological renal inflammatory activity and/or damage may persist despite clinically silent disease after treatment.…”

mentioning

confidence: 99%

Towards the identification of multi-parametric quantitative MRI biomarkers in lupus nephritis

Rapacchi

Smith

Wang

et al. 2015

Magnetic Resonance Imaging

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Keywords:Renal function Multi-parametric quantitative MRI (qMRI) Arterial spin labeling (ASL) Blood oxygen level dependent (BOLD) T1rho MRI Lupus nephritis (LN) Purpose: To identify potential biomarkers of the renal impairment in lupus nephritis using a multi-parametric renal quantitative MRI (qMRI) protocol including diffusion weighted imaging (DWI), blood oxygen level dependent (BOLD), arterial spin labeling (ASL) and T1rho MRI between a cohort of healthy volunteers and lupus nephritis (LN) patients. Materials and methods: The renal qMRI protocol was performed twice with repositioning in between on 10 LN patients and 10 matched controls at 1.5 T. Navigator-gated and breath-hold acquisitions followed by non-rigid image registration were used to control respiratory motion. The repeatability of the 4 MRI modalities was evaluated with the intra-class correlation coefficient (ICC) and within-subject coefficient of variation (wsCV). Unpaired t-test and stepwise logistic regression were carried out to evaluate qMRI parameters between the LN and control groups. Results: The reproducibility of the 4 qMRI modalities ranged from moderate to good (ICC = 0.4-0.91, wsCV ≤ 12%) with a few exceptions. T1rho MRI and ASL renal blood flow (RBF) demonstrated significant differences between the LN and control groups. Stepwise logistic regression yielded only one significant parameter (medullar T1rho) in differentiating LN from control groups with 95% accuracy. Conclusion: A reasonable degree of test-retest repeatability and accuracy of a multi-parametric renal qMRI protocol has been demonstrated in healthy volunteers and LN subjects. T1rho and ASL RBF are promising imaging biomarkers of LN.

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Strategy for second kidney biopsy in patients with lupus nephritis

Abstract: Second kidney biopsy at the end of maintenance phase of therapy is an important diagnostic and prognostic tool that could guide physicians to safer practices with better outcomes.

Cited by 70 publications

References 23 publications

Update on Lupus Nephritis

Update on Lupus Nephritis

Lupus nephritis: When and how often to biopsy and what does it mean?

Towards the identification of multi-parametric quantitative MRI biomarkers in lupus nephritis

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