Abstract: TH-PO792
Value of Repeat Renal Biopsies in Lupus Nephritis in Two Large Inner-City Hospitals in New York
Session Information
- Pathology and Lab Medicine - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1800 Pathology and Lab Medicine
Authors
- Hti Lar Seng, Nang San, New York City Health and Hospitals Jacobi, Bronx, New York, United States
- Santana De Roberts, Rosalba Y., New York City Health and Hospitals Jacobi, Bronx, New York, United States
- Ramu, Anitha, Montefiore Medical Center, New York, New York, United States
- Peringeth, Gopisree, New York City Health and Hospitals Jacobi, Bronx, New York, United States
- Golestaneh, Ladan, Montefiore Medical Center, New York, New York, United States
- Jim, Belinda, New York City Health and Hospitals Jacobi, Bronx, New York, United States
Background
Class transition is common in lupus nephritis (LN) patients and may affect treatment. While the initial biopsy is indicated for the diagnosis, the role of repeat renal biopsies during renal flares is controversial. We retrospectively evaluated the histopathological and treatment changes associated with repeat renal biopsies in LN patients.
Methods
Fifty-six LN patients with at least 2 renal biopsies were included at Jacobi Medical Center and Montefiore Medical Center in Bronx, NY. Statistical analysis was performed using STATA 18 (StataCorp).
Results
The study cohort consisted of 80.4% (45/56) female, 48.2% (27/56) Black, and 42.8% (24/56) Hispanic patients, with a mean age of 26.4 ± 13.1 at the initial biopsy. The most common LN classes were proliferative, accounting for 62.9% and 80.8% of the identified classes in the 1st and 2nd biopsies respectively. There were no differences between the mean activity indices between the 1st and 2nd biopsies (1.89 ± 2.11 vs 2.10 ± 2.07, p =0.666). Mean chronicity indices were significantly higher in the 2nd vs. 1st biopsies (5.05 ± 2.60 vs 2.69 ± 2.19, p <0.001). Class switch occurred in 52% (26/50) of the repeat biopsies. Among the proliferative classes, 35% (11/31) had class switch within the proliferative categories (mixed class to III or IV or vice versa, or III to IV or vice versa), 6% (2/31) transitioned to class V, and 3% (1/31) to class II. Eighty percent (8/10) of the mixed III/IV+V class remained histologically unchanged in the repeat biopsies. Among non-proliferative classes, 75% (6/8) transitioned to proliferative classes (III,IV,or III/IV+V). Class switch during flares occurred more frequently in the non-proliferative classes compared to the proliferative classes (63% vs 45%, p=0.013). In the end, 64% of patients had escalation in their immunosuppression, 17% had de-escalation, and 19% had no change.
Conclusion
Repeat biopsies were found to be particularly important in those with non-proliferative class of LN at the initial biopsy since transition to proliferative class occurred in a majority of these cases. Further, a class switch occurred in more than half the patients and a majority of the patients had an escalation of therapy, suggesting the benefit of repeat biopsies during flare in our largely minority population.