REPEAT kidney biopsies may play an essential role in managing lupus nephritis, particularly for patients whose disease transitions between proliferative and non-proliferative classes, according to a recent study led by Anitha Ramu, Montefiore Medical Center, New York, USA.
The study, conducted from 2000–2020, involved a diverse cohort of 55 adult and paediatric patients, 56% experienced a change in lupus nephritis class upon repeat biopsy, which led to treatment adjustments in 87%, from Montefiore Medical Center and Jacobi Medical Center in New York. Most participants were women (82%), with a significant representation of Black (51%) and Hispanic (47%) patients, groups that are often disproportionately affected by lupus nephritis. The median age at first biopsy was 25 years, and 27 years at the time of the repeat biopsy. Lupus nephritis was confirmed through two or more biopsies according to the International Society of Nephrology/Renal Pathology Society classification from 2003.
The interval between the initial and repeat biopsies averaged 3 years and the repeat biopsies were typically prompted by persistent proteinuria following immunosuppressive therapy, worsening kidney function, or inadequate response to standard treatment. The findings reveal that 64% of initial biopsies showed proliferative lupus nephritis, a figure that increased to 75% upon repeat biopsy. Among those with initial proliferative disease, 51% showed no change, while 32% shifted within the proliferative class.
Notably, some patients initially diagnosed with proliferative lupus nephritis experienced escalation in disease severity, with 69% showing an increase in class, 23% experiencing a reduction, and 9% remaining unchanged. In contrast, among participants with non-proliferative lupus nephritis at first biopsy, 60% progressed to a proliferative class, necessitating intensified treatment for 80% of this group.
Ultimately, 73% of patients required treatment escalation, mainly due to worsening lupus nephritis or failure to respond to initial treatments. On the other hand, 20% needed reduced treatment, often due to increased chronicity or recurrent infections rather than changes in disease class. These findings highlight the potential benefits of repeat biopsies for managing lupus nephritis, especially in racially diverse populations where treatment responsiveness and disease progression vary significantly.
Katie Wright, EMJ
Reference
Ramu A et al. The role of repeat kidney biopsies in lupus nephritis in a largely Black and Hispanic population. Clin J Am Soc Nephrol. 2024;DOI:10.2215/CJN.0000000000000556.
