Estudio de la concordancia entre la opinión clínica de los reumatólogos con respecto a la necesidad de inmunosupresión y el resultado de la biopsia renal en pacientes adultos con nefritis lúpica

Abstract

IntroductionIn patients with lupus nephritis it is necessary to define the need for immunosuppressive therapy according to histological class observed in renal biopsy. ObjectiveTo evaluate the agreement between the opinions of six independent clinical rheumatologists regarding the need for immunosuppression and the result of renal biopsy in patients with lupus nephritis. Materials and methodsA cross-sectional study on the agreement between a diagnostic test in adult patients with systemic lupus erythematosus. Each rheumatologist predicted the outcome of the biopsy. In order to evaluate the agreement, a dichotomous qualitative outcome was defined and was considered zero if it was not necessary to add a cytotoxic (classes I, II and VI), and otherwise was (classes III, IV, V or combinations). The percentage agreement and kappa statistics with a confidence interval of 95% was measured. ResultsInformation was collected on 34 patients, with a total of 204 predictions made by 6 rheumatology interns. Rheumatologists were correct in their clinical impression in 180 cases (88.2% concordance rate, overall kappa of 0.62 (95% CI=0.48 to 0.76)). Of the 204 scenarios generated, 162 corresponded to proliferative forms of lupus nephritis, for which the rheumatologists anticipated the need for immunosuppression in 153 and failed to treat in 9 cases (5.5%, or about 1 in 18). ConclusionsThe clinical opinion of rheumatologist is quite successful in defining the need for immunosuppression. In general, expert opinion could eventually be offered as an alternative choice to renal biopsy for the patient.