Abstract: FR-PO0707
Repeat Kidney Biopsies and Class Switching in Pediatric Lupus Nephritis
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Chati, Priyanka, Ann and Robert H Lurie Children's Hospital of Chicago Foundation, Chicago, Illinois, United States
- Kallash, Mahmoud, Nationwide Children's Hospital, Columbus, Ohio, United States
- Wenderfer, Scott E., Texas Children's Hospital, Houston, Texas, United States
- Blatt, Neal B., C S Mott Children's Hospital, Ann Arbor, Michigan, United States
- Batisky, Donald Lee, Emory University, Atlanta, Georgia, United States
- Quiroga, Alejandro, Pediatrics Residency Program at Helen DeVos Children's Hospital, Grand Rapids, Michigan, United States
- Vasylyeva, Tetyana, Texas Tech University System, Lubbock, Texas, United States
- de Jesus-Gonzalez, Nilka, Universidad de Puerto Rico, San Juan, San Juan, Puerto Rico
- Lane, Jerome C., Ann and Robert H Lurie Children's Hospital of Chicago Foundation, Chicago, Illinois, United States
Background
Lupus nephritis (LN) remains a common complication associated with increased morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients with LN often experience flares that can compromise renal function and complicate disease management. Repeat kidney biopsies, often performed during flares or for surveillance, may reveal a change in the pathologic class of LN, a phenomenon known as class switching. While class switching has been well-described in adults, data for pediatric lupus nephritis (pLN) is limited.
Methods
The Prospective Pediatric Lupus Nephritis Registry (ProPeL) is a multicenter, prospective study from the Pediatric Nephrology Research Consortium (PNRC) that enrolled pLN patients <21 years of age within 4 weeks of an initial kidney biopsy diagnostic of pLN, with follow-up for up to 5 years. Among 112 patients with biopsy-proven Class III, IV, V or mixed LN, a cohort of 39 underwent repeat kidney biopsies. We evaluated this cohort regarding the frequency of class switching and degree of interstitial fibrosis progression.
Results
On repeat kidney biopsy, class severity decreased overall—Class I, II, and V became more common compared to initial Class IV/IV+V (Figure 1). However, interstitial fibrosis worsened in degree. Class switching occurred in most patients: 56.4% improved, 15.4% worsened, and 28.2% remained unchanged. These findings suggest that histologic evolution is common in pediatric LN, regardless of treatment status.
Conclusion
This is the first prospective pLN study showing class switching is common. Despite standard therapy, nearly 15% of patients showed progression to worsening LN class or degree of fibrosis, highlighting current treatment limitations. These findings support the need for better monitoring tools and standardized indications for repeat biopsies to improve long-term outcomes.
Figure 1: Initial vs Repeat Biopsy Class