Abstract: FR-PO886
The Value of Repeated Kidney Biopsies in Patients with Lupus Nephritis
Session Information
- Glomerular Diseases: Membranous Nephropathy, SLE, Complement
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Bada Bosch, Teresa, Hospital Universitario 12 de Octubre, Madrid, Spain
- Alonso riaño, Marina, Hospital Universitario 12 de Octubre, Madrid, Spain
- Gutierrez-solis, Elena, Hospital Universitario 12 de Octubre, Madrid, Spain
- Trujillo Cuellar, Hernando, Hospital Universitario 12 de Octubre, Madrid, Spain
- Redondo navarro, Beatriz, Hospital Universitario 12 de Octubre, Madrid, Spain
- Fernández vidal, María, Hospital Universitario 12 de Octubre, Madrid, Spain
- Canllavi fiel, Elizabeth, Hospital Universitario 12 de Octubre, Madrid, Spain
- Aubert, Lucia, Hospital Universitario 12 de Octubre, Madrid, Spain
- Sandino Perez, Justo, Hospital Universitario 12 de Octubre, Madrid, Spain
- Morales, Enrique, Hospital Universitario 12 de Octubre, Madrid, Spain
Background
The indication to repeat renal biopsy in lupus nephritis (LN) flare is controversial. Studies with protocol biopsies had shown a mismatch between clinical and pathological remission, giving even more importance to repeated biopsies. The aim of our study was to evaluate the pathological changes in patients with LN with a repeated biopsy
Methods
We analyzed 107 patients with LN biopsied between 1990-2018, we selected 26 patients who had had 2 renal biopsies
Results
Mean age at the diagnosis of LN was 29.6±3 years, 73.1% female and 73.1% caucasic. At 1 biopsy 30.7% of the patients were class II, 7.7% class III, 38.5% class IV, 11.5% class V and 11.5% mixed class. Cyclophosphamide was the induction treatment in 53.8% of patients and mycophenolate in 23.1%. Time between biopsies was 71.5±10.7 months. Proteinuria was the most common reason to repeat biopsy (73.1%). At 2 biopsy, patients had lower SLEDAI (12 vs 16, p 0.00) and less number of patients had anti-dsDNA antibodies (46.2 vs 73.1%, p 0.03). There were no differences in creatinine (SCr), proteinuria or complement. 73.1% of patients change of class at 2 biopsy; 38.4% to a higher and 34.6% to a lower class. There were no differences in analytical data between patients who changed class and those who didn't. Most patients 75% with class II changed to a proliferative class, while only 16.6% of patients with proliferative classes change to non-proliferative and 16.6% to a mixed class. There was an increased in chronicity index (CI) between biopsies (1 vs 3, p<0.001) and no difference in activity index. At the end of follow up (163.6 months), 38.5% patients had chronic kidney disease (CKD) and 19.2% end stage renal disease. Patients with CKD had more percentage of glomerulosclerosis (%GE) at first biopsy (8.7% vs 1.2%, p 0.02) and higher CI at second(4 vs 2, p 0.006). They also had less rate of complete remission (CR) at 12 months (0% vs 37.5%, p 0.02) and higher SCr (1.7 vs 0.9 mg/dl, p 0.004) and proteinuria (3.1 vs 4.5g/24h, p 0.02) at second biopsy
Conclusion
Our study suggests the utility of repeated renal biopsies as 38.4% of patients changed to a higher class without relevant clinical expression. The percentage of CR at 12 month, %GE and CI were the main prognosis factors for CKD