The clinical significance of serial kidney biopsies in lupus nephritis

Abstract

Objectives. Repeated kidney biopsies are increasingly recognized to be pivotal in the management of various phases of lupus nephritis. The aim of this retrospective study was to examine the shift in activity index and chronicity index among International Society of Nephrology/Renal Pathology Society (ISN/RPS) class patients with lupus nephritis who undergo a triple kidney biopsy.Methods. Eleven patients with lupus nephritis and 3 biopsies each were assessed and reclassified based on ISN/RPS classification.Results. The mean creatinine level increased from 74 (± 38) μmol/l at baseline to 129 (± 116) μmol/l at the second biopsy and to 204 (± 200) μmol/l at the last biopsy. Among 11 kidney biopsies, 7 (63.7%) had a different ISN/RPS class in the second biopsy. The third biopsy showed that six kidney biopsies had a different ISN/RPS class compared to the second biopsy. Even among patients who stayed in the same ISN/RPS class, the second and third biopsies gave a different activity and/or chronicity index. The median activity index (range) was 3.1 (0–14), 4 (0–13) and 3 (0–14) for the first, second and third biopsies, respectively. The median chronicity indices (range) were 2.5 (0–8), 7 (0–8) and 5 (0–10), respectively.Conclusion. My study has shown that lupus nephritis is a shifting disease, and repeated biopsies are a pivotal policy in its management.