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Abstract: FR-PO641

The Value of Repeat Kidney Biopsy-Based Directed Management of Lupus Nephritis: A Pilot Study in a Single Centre

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Ooi, Li Jin, Royal Preston Hospital, Preston, Lancashire, United Kingdom
  • Ding, U Zhe, Royal Preston Hospital, Preston, Lancashire, United Kingdom
  • Ponnusamy, Arvind, Royal Preston Hospital, Preston, Lancashire, United Kingdom
Background

The duration of maintenance therapy for lupus nephritis (LN) has no fixed guidance at present. It has also been established that there is a discordance between clinical and histological remission. Studies have suggested using histological findings from a repeat renal biopsy as an adjunct to clinical parameters to guide treatment. We undertook a pilot study in a tertiary centre to assess the feasibility of repeat kidney biopsy in directing the management of LN.

Methods

Patients with biopsy-proven active lupus nephritis which include class 3,4,5 who had a subsequent planned elective biopsy at our centre (n=7). Disease activity was assessed using the NIH activity (AI) and chronicity indices (CI), Therapeutic management was then modified based on activity and chronicity index from second renal biopsy. AI > 2 was considered for continuation of immunosuppression and maintenance therapy to be reduced or stopped for those with lower AI index.

Results

The mean age of the first presentation of lupus nephritis was 51±14.1 years, 6 of whom were female. The median period between the first and subsequent biopsy was 29.9 months. Mean eGFR at first biopsy was 56.2±21.4, 70.5±19.5 at second biopsy and 65±21 at last follow up. uPCR at first biopsy was 666.3±393.2 mg/mmol, 80.6±134.3 mg/mmol at second biopsy and 57.7±88.6 mg/mmol at last follow up. Mean activity index was 7.5±3.3 at first biopsy and 0.67±0.82 ( p<0.05) at second biopsy whilst the mean chronicity index was 1.17±0.98 at the first biopsy and 2.17±1.17 ( p<0.05) at the second biopsy. Following the results from the second biopsy, Immunosuppression therapy was escalated for 1 patient, reduced for 4 patients, and stopped for 2 patients of whom both had no further relapse at the last follow up.

Conclusion

Our pilot study suggests that renal biopsy is a valuable tool alongside clinical parameters. Repeat kidney biopsy may prevent unnecessary continuation of immunosuppression without the risk of relapse. The data also showed that induction immunosuppression and rapid control of clinical disease activity did not necessarily prevent chronic damage in LN suggesting that there may be a role for anti-fibrotic agents. No adverse events were associated with the biopsies done in this cohort suggesting that this is safe. The data above was limited by its single-centre retrospective nature and small sample size.