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Abstract: FR-PO1103

Characteristics Associated with Repeat Native Renal Biopsy in Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Singh, Harpreet K., University of North Carolina , Chapel Hill, North Carolina, United States
  • Hogan, Susan L., University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, United States
  • Poulton, Caroline J., UNC Kidney Center, Chapel Hill, North Carolina, United States
  • Hu, Yichun, UNC Kidney Center & Dividdions of Nephrology & Hypertension, Chapel Hill, North Carolina, United States
  • Nachman, Patrick H., University of Minnesota, Minneapolis, Minnesota, United States
Background

There is great interest in using repeat kidney biopsies to determine the response to treatment and outcomes of patients with lupus nephritis (LN). Although some patients with lupus nephritis undergo a repeat kidney biopsy, the factors that lead to the decision to repeat a biopsy and how the repeat biopsy alters treatment are not well understood. We evaluated the timing and explored factors associated with repeat kidney biopsy.

Methods

We identified 42 patients > 18 years old with biopsy proven LN who underwent a repeat native renal biopsy from 2010 to 2018. A retrospective review was performed focusing on the clinical and histopathologic characteristics associated with a repeat biopsy. Both the reference and repeat biopsies were evaluated via the ISN/RPS classification.

Results

Of the patients included, 37 (88%) were women, 30 (71%) were black. The median age at reference biopsy was 28.74 years (IQR: 22.41, 37.77) and 34.33 years (26.70, 43.58) at repeat biopsy. The median interval time to repeat biopsy 2.96 (2.21, 7.83). The interval time between biopsies increased over the selected time period. The serum creatinine increased between reference and repeat biopsies (median 1.12 (0.1, 1.70) vs. median 1.38 (0.90, 2.54)). The results of the clinical and histological factors are addressed in the figure below.

Conclusion

Several factors were associated with the decision to repeat a native kidney biopsy in patients with lupus nephritis including time from reference biopsy, elevated serum creatinine, active urine sediment, hypoalbuminemia, and anti dsDNA positivity. The decision to repeat a biopsy was associated with a change in immunosuppression for the majority of our cohort. Looking ahead, we hope to use these clinical and histopathologic factors to establish and clarify how a repeat biopsy can lead to changes in management in our patients with lupus nephritis.