Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Second Renal Biopsy in Proliferative Lupus Nephritis.
Allievi2, Alberto, Perrin2, Ana Malvar, Lococo2, Bruno, Basta2, Mariac Cristina, Pirruccio2, Paola, Munoz2, Sebastian Andres, Quevedo2, Alejandra
Renal biopsy is one of the main diagnostic tools in lupus nephritis. Disease activity and prognosis can be established through a systematic light microscopic and indirect immunofluorescence analysis of renal tissue. Ultrasonographic guided biopsy has made the collection of renal tissue a common and safe procedure in clinical nephrology. Frequently only clinical parameters are used to evaluate therapeutic response. Correlation between clinical response and histopathology is not always present.
To compare the predictive value of clinical and histopathological criteria after six month of induction therapy in diffuse proliferative lupus nephritis at two years.
thirty three SLE patients with diffuse proliferative lupus nephritis were evaluated prospectively between august 2002 and september 2007. A second renal biopsy was performed after induction treatment with six pulses of cyclophosphamide in 29 patients and sodium mycophenolate in four patients. All patients completed 2 years of maintenance treatment. Responders were treated with azathioprine. We compared between clinical parameters and second renal biopsy findings as predictors of clinical outcome after 24 months. Renal biopsies were evaluated by two experienced renal pathologists blinded to clinical data. The ISN/RPS 2003 classification was used. Serum creatinine levels and 24 hr proteinuria were compared with the second biopsy histopathological findings as predictors of clinical outcome after 24 months. Patients were categorized according to their response to treatment. Those patients with complete or partial response were defined as responders. Clinical response was based on increase or decrease of 24 hs proteinuria and creatinine. Histological response was assesses according to the activity and chronicity index. The increase of both parameters was considered no response, the disparity of both was apartial response and the improvement of both parameters was considered response.
Thirty three patients were assessed according to the protocol. We have biopsy results for all of them and they have been followed for 2 years. Seven patients presented membranous glomerulopathy in the second renal biopsy, 6/7 had good clinical evolution two years later. 19/26 patients with good clinical response after induction treatment were in low concordance with clinical evolution two years after (46.15 %; Spearman's: 0.1785, Kappa: 0.13). Second renal biopsy performed after induction treatment revealed information more accurate about two years clinical evolution with concordance of 73.08 % (Spearman's: 0.57, Kappa: 0,50, p<0,001).
In our experience, membranous nephropathy in the second renal biopsy was coincidental with good clinical evolution. Second renal biopsy revealed more accurate information than clinical evolution.
To cite this abstract, please use the following information:
Allievi, Alberto, Perrin, Ana Malvar, Lococo, Bruno, Basta, Mariac Cristina, Pirruccio, Paola, Munoz, Sebastian Andres, et al; Second Renal Biopsy in Proliferative Lupus Nephritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1173