The value of repeat kidney biopsy in lupus nephritis. A systematic review

Sánchez-Cubías, Susy Marcela; Guaracha-Basáñez, Guillermo; Sandoval-Flores, María Graciela; Domínguez-Quintana, Maricruz; Romero-Díaz, Juanita

doi:10.1016/j.rcreu.2021.02.003

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…Baseline and repeat biopsies were evaluated by two experienced nephropathologists, processed with light and immunofluorescence microscopy and classified using the 2003 ISN/RPS classification of LN [ 7 ]. Biopsy samples were processed using haematoxylin and eosin, periodic acid–Schiff, Masson’s trichome and methenamine-silver staining; immunofluorescence reports scored intensity on a 0–3+ scale.…”

Section: Methodsmentioning

confidence: 99%

“…On the one hand, the latest update of the European League Against Rheumatism (EULAR) recommendations for the management of LN only suggests the gradual withdrawal of treatment in patients in complete renal response (CRR) after 3–5 years of treatment but does not include a new biopsy to guide this decision. On the other hand, protocol repeat biopsies have shown considerable discrepancies between clinical and histological findings [ 7 ]. Data from observational studies [ 8–12 ] suggest that a repeat biopsy may help guide the decision to intensify, withdraw or maintain immunosuppression therapy.…”

Section: Introductionmentioning

confidence: 99%

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Kidney biopsy in lupus nephritis after achieving clinical renal remission: paving the way for renal outcome assessment

Lledó-Ibáñez

Xipell

Ferreira

et al. 2022

Clinical Kidney Journal

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The role of repeat kidney biopsy in lupus nephritis with renal remission is unclear. The aim of this study is to assess this role in a real-life scenario. This retrospective, single-centre study included 56 patients with lupus nephritis diagnosed from 1998 to 2019, with an initial kidney biopsy (KB1) at the onset of lupus nephritis and a second kidney biopsy (KB2) after achieving renal remission. Fifty-one (91.1%) patients were women with a median age of 29.9 [23.4–40.6] years at the time of lupus nephritis diagnosis. KB2 were performed after 41.1 [30.1–52.5] months of KB1. At the time of KB2, complete renal response was achieved in 51 (91.1%) patients. Median activity index decreased from a baseline value of 6.5 [2.8–11] to 0 [0–2] (p < 0.001). Chronicity index worsened from 1 [0–2] to 2 [1–3] (p = 0.01). In patients with proliferative/mixed forms at KB2, chronicity index median value increased to 3 [1.5–4], as well as interstitial fibrosis and tubular atrophy $\ge $ 25%, from 5.4% to 13.5%. Persistent histological active lupus nephritis (activity index ≥ 2) was presented in 11 (19.6%) of KB2. There were no differences when comparing immunological parameters between both groups (activity index ≥ 2 versus < 2) at KB2, nor in the percentage of patients who presented renal flare. Immunosuppressive treatment was withdrawn in 35 (62.5%) patients and maintained/switch in 21 (37.5%). Afterwards, new renal flare occurred in 9 patients per group (25.7% and 43%, respectively), after a median time of 39 [6.5–55] months and 7 [6–30] months, respectively. There was no difference in the number of patients who developed chronic kidney disease (n = 14, 25%) according to the treatment. In conclusion, KB2 provides valuable information to guide the immunosuppressive maintenance therapy.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Kidney biopsy in lupus nephritis after achieving clinical renal remission: paving the way for renal outcome assessment

Lledó-Ibáñez

Xipell

Ferreira

et al. 2022

Clinical Kidney Journal

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An old acquaintance with new trends: Systemic lupus erythematosus

Quintana-López

Vásquez

Cervera

2021

Revista Colombiana de Reumatología

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Analysis of Albumin to Globulin Ratio as A Prognostic Predictor in Lupus Nephritis Patients

Serel,

Widaningsih,

Mangarengi

2024

Indonesian J. Clin. Pathol. Med. Lab.

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Lupus Nephritis (LN) is a manifestation of Systemic Lupus Erythematosus (SLE), which targets the kidney. Based on histopathology, the World Health Organization divides the disease into five classes: normal pattern, mesangial, focal, diffuse proliferative, and membranous. Albumin to Globulin Ratio (AGR) compares serum albumin with serum globulin levels. Low AGR value is associated with poor prognosis of diseases such as cancer, liver cirrhosis, and other chronic inflammatory diseases such as LN. This study aimed to analyze the AGR value as a prognostic predictor in LN patients based on disease classes with a retrospective descriptive cross-sectional approach. Total subjects were 109, which consisted of class 1 (n=15), class 2 (n=37), class 3 (n=9), class 4 (n=21), and class 5 LN (n=27). Data of disease classes, serum albumin, and serum globulin/total protein levels were collected. SPSS version 25, Mann-Whitney, Kruskal-Wallis, Chi-Square, and Spearman's correlation test were used for statistical analysis. The ROC curve determined the cut-off. Test results were significant if p <0.05. The lowest mean AGR value (0.79) was found in class 4 LN (p<0.05). The optimal cut-off AGR was 1.10 to categorize mild-moderate and severe degrees. AGR prognostic value: sensitivity=95.8%; specificity=78.8%; Positive Prediction Value (PPV)=78.0%; Negative Prediction Value (NPV)=96.0%, accuracy = 86.2%. There was a negative strong correlation between the AGR value and LN class with a correlation coefficient R of -0.777 (p<0.001). AGR marker has a good sensitivity and specificity as a predictor of LN progression.

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The value of repeat kidney biopsy in lupus nephritis. A systematic review

Cited by 3 publications

References 22 publications

Kidney biopsy in lupus nephritis after achieving clinical renal remission: paving the way for renal outcome assessment

Kidney biopsy in lupus nephritis after achieving clinical renal remission: paving the way for renal outcome assessment

An old acquaintance with new trends: Systemic lupus erythematosus

Analysis of Albumin to Globulin Ratio as A Prognostic Predictor in Lupus Nephritis Patients

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