Systematic review of the literature on reproducibility of the interpretation of renal biopsy in lupus nephritis

Abstract

Objective Before using a test, it should be determined whether the results are reliable. The reliability of the interpretation of renal biopsy in patients with lupus nephritis has not been clearly elucidated. Our objective was to estimate inter and intra-observer reliability of the histological classification, as well as activity and chronicity indices in renal biopsy of patients with lupus nephritis. Methods We conducted a systematic search of the literature, which included articles in any language, using PubMed, Embase, Cochrane and Lilacs databases. Search terms included were: reproducibility, reliability, agreement, systemic lupus erythematosus and lupus nephritis. Comparative studies with any design were included, regardless of the year or the language of publication. Two investigators, independently, screened the literature published in accordance with pre-established inclusion and exclusion criteria. Results We found 13 relevant studies. Inter-observer reproducibility of most measurements was moderate or low, despite the fact that, in most cases, the readings were made by expert nephropathologists. There was great diversity among designs, participants, including samples and outcomes evaluated in different studies. Although there are too many reports on the clinical use, studies evaluating the reliability of classifications on renal biopsy in lupus nephritis are rare. The quality of the methodological design and reporting was fair. Conclusion The interpretation of renal biopsy in lupus nephritis is poorly reproducible, causing serious doubts about its validity and its clinical application. As it can lead to serious diagnosis, treatment and prognosis errors, it is necessary to intensify research in this field.

Interstitial inflammation and interstitial fibrosis and tubular atrophy predict renal survival in lupus nephritis

“…The majority of disagreements in our study were the result of a grading change from absent to mild or mild to moderate and infrequently resulted in a change in risk category (∼19%). Reproducibility of ISN/RPS class further complicates risk stratification and the clinical utility of grading interstitial lesions has not been established [ 42 , 43 ].…”

Urinary biomarkers in lupus nephritis

“…It can serve as a guide for immunosuppressive therapy selection. However, the current LN classification system that is based on renal biopsy is difficult to reproduce, resulting in doubts about its clinical application [ 3 ]. Furthermore, the current classification of LN does not include certain histological findings—thrombotic microangiopathy, vasculitic lesions, and lupus vasculopathy—that can modify the management decision and be associated with a worse renal prognosis.…”

Stellenwert der Nierenbiopsie bei Lupusnephritis

“…In einer kürzlichen Arbeit wurden die wenigen existierenden Studien zur Reproduzierbarkeit der Nierenbiopsieergebnisse bei LN zusammengefasst [22]. Nach dieser Analyse ist die Reproduzierbarkeit bei geringer Qualität der vorliegenden Studien trotz erfahrener Nephropathologen gering ausgefallen [22].…”