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Kidney Week

Abstract: FR-PO1095

What Is the Value of a Repeat Kidney Biopsy in Children and Young Adults with Lupus Nephritis?

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Radhakrishna, Suhas M., UC San Diego/Rady Children''s Hospital, San Diego, California, United States
  • Chang, Johanna, UC San Diego/Rady Children''s Hospital, San Diego, California, United States
  • Sheets, Robert, UC San Diego/Rady Children''s Hospital, San Diego, California, United States
  • Yorgin, Peter D., UC San Diego/Rady Children''s Hospital, San Diego, California, United States
Background

Adult lupus nephritis (LN) studies have shown a lack of correlation between follow-up kidney biopsy results and clinical parameters. This study investigated whether kidney biopsy findings in children and young adults with LN performed after induction and maintenance therapy would better determine the response to medical therapy than clinical parameters.

Methods

64 subjects, 11-18 yrs of age, met 1997 revised ACR classification criteria for systemic lupus erythematosus (SLE) with biopsy proven LN at Rady Children’s Hospital in San Diego between 1/1/2005 - 1/1/15. 12 subjects had a repeat biopsy 1 yr after diagnosis and 14 additional subjects had a repeat biopsy within 5 yrs of diagnosis. ACR criteria for complete remission (CR), partial remission (PR) and no remission (NR) were assessed at the time of repeat biopsy. Correlation between clinical remission status and biopsy findings was investigated. The study had IRB approval (#161748X, 6/30/17).

Results

At the time of repeat biopsy, 6 of 26 subjects achieved CR, 3 subjects achieved PR and 17 subjects had NR. Changes in IgG deposition, activity, and chronicity were statistically significant between the CR and NR groups. However, within CR and NR groups there were unexpected results: Among the 6 subjects achieving CR, 4 had the same or worse WHO class, 1 had higher activity and 3 had higher chronicity scores at the time of repeat biopsy. Among the 17 NR subjects, 5 had better or stable WHO classification. Furthermore, repeat kidney biopsies led to significant changes in therapy in both CR and NR groups.

Conclusion

In general, there was poor concordance between ACR remission criteria and repeat biopsy findings in children who achieved CR and NR, with notable exceptions. The discrepancy between clinical findings and kidney biopsy results in such cases should be further investigated. The large number of NR patients likely reflects bias toward repeat biopsy in clinical non-responders.

Comparison of Complete and No ACR Remission Groups
 WHO ClassAntibody DepositionBiopsy ActivityBiopsy ChronicityLaboratory Results
Complete remission (n=6; all females)Better
3 → 2
4 → 2

Same
2 → 2
3 → 3
4 → 4

Worse
4 → 4 +5
IgG: 2.0 ± 0.6 → 0.8 ± 0.9
IgM: 1.9 ± 0.8 → 0.8 ± 0.3
IgA: 1.8 ± 0.9 → 0.5 ± 0.8
C3: 2.2 ± 0.4 → 0.9 ± 0.9
C1q: 1.8 ± 0.7 → 0.7 ± 0.8
5.8 ± 4.1
→ 2.2 ± 1.5
1.3 ± 2.0 → 1.7 ± 0.5eGFR: 131.6 ± 72.5 →144.9 ± 26.9
C3: 50.3 ± 16.9 → 94.0 ± 16.8
DSDNA: 5864.4 ± 8737.2 → 42.6 ± 33.6
Albumin: 3.5 ± 0.6 → 4.3 ± 0.3
UProt/Ucreat: 4.4 ± 6.5 → 0.1 ± 0.1
uRBC: 1.8 ± 1.3a → 0.4 ± 0.0
No remission (n = 17; 2 males, 15 females)Better
4+5 → 5

Same
4 → 4 (n=6)
5 → 5
3+5 → 3+5
4+5 → 4+5

Worse
2 → 5
3 → 4
4 → 3 +5
4 → 4 +5 (n=2)
5 → 3 + 5
5 → 4+ 5
IgG: 1.9 ± 0.8 → 1.9 ± 0.7*
IgM: 0.8 ± 0.6* → 0.8 ± 0.6
IgA: 1.5 ± 0.7 → 1.0 ± 0.8
C3: 2.3 ± 0.6 → 1.4 ± 0.8
C1q: 1.5 ± 0.8 → 1.2 ± 0.9
5.6 ± 4.1
→ 4.4 ± 2.5*
2.1 ± 1.8
→ 3.7 ± 2.6*
eGFR: 120.2 ± 30.7 → 135.9 ± 44.0
C3: 50.9 ± 25.5 → 85.0 ± 25.2
DSDNA: 2947.0 ± 6547.8 → 85.0 ± 25.2
Albumin: 2.9 ± 0.7* → 3.4 ± 0.9*
UProt/Ucreat: 5.5 ± 7.2 → 6.5 ± 9.2*
uRBC: 22.0 ± 76.9 → 5.3 ± 8.9

All columns show results at the time of the initial and repeat kidney biopsy. * statistical difference (p<0.05) between CR and NR groups.