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NDT Advance Access published online on July 21, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp359
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The clinical relevance of a repeat biopsy in lupus nephritis flares

Gabriëlle M. N. Daleboudt1, Ingeborg M. Bajema2, Natascha N. T. Goemaere3, Jaap M. van Laar4, Jan A. Bruijn2 and Stefan P. Berger1,5

1 Department of Nephrology 2 Department of Pathology, Leiden University Medical Center, Leiden 3 Department of Pathology, Erasmus University Rotterdam, Rotterdam, The Netherlands 4 Department of Musculoskeletal Research Group, Newcastle University, UK 5 Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands

Correspondence and offprint requests to: Stefan P. Berger; E-mail: s.p.berger{at}lumc.nl



  Abstract

Background. The clinical utility of performing repeat biopsies during lupus nephritis flares is questionable and data pointing towards frequent class switches are based on the old WHO classification. This retrospective study investigates the hypothesis that clinically relevant switches from proliferative to non-proliferative lesions and vice versa as determined by the new ISN/RPS classification are a rare event and that repeat biopsies are unnecessary in many cases.

Methods. Thirty-five patients with lupus nephritis and one or more repeat renal biopsies were included. Eighty-four biopsies were blindly reassessed according to the ISN/RPS classification.

Results. Twenty-five patients had one repeat biopsy, 6 patients had two and 4 patients had three repeat biopsies. Forty-nine comparisons between reference and repeat biopsies could be made. In 25 cases (54.3%), there was no shift in ISN/RPS class on repeat biopsies. In 41 instances, paired biopsies showed proliferative lesions both on reference and repeat biopsies, whereas five of six cases with non-proliferative lesions on a reference biopsy switched to proliferative lesions on a repeat biopsy. Clinically significant class switches during lupus nephritis flares were more frequent in patients with non-proliferative lesions in their reference biopsy (P < 0.001).

Conclusion. The results show that patients with proliferative lesions in the original biopsy rarely switch to a pure non-proliferative nephritis during a flare. Therefore, a repeat biopsy during a lupus nephritis flare is frequently not necessary if proliferative lesions were found in the reference biopsy. However, in the case of a non-proliferative lesion in the reference biopsy, class switches are frequently found and repeat biopsies are advisable.

Keywords: ISN/RPS classification; kidney biopsy; lupus nephritis; proliferative lesions; SLE

Received for publication: 11.12.08
Accepted in revised form: 29. 6.09


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