Value of repeat biopsy in lupus nephritis flares.
OBJECTIVE
Renal flares are common in lupus nephritis (LN), and class switch is thought to be characteristic. There is no agreement on indications for performing a repeat renal biopsy. Our objective was to retrospectively review patients who had more than one renal biopsy performed on clinical indications, and analyse clinical, pathological and treatment changes after successive biopsies.


METHODS
Forty-five patients with LN and one or more repeat renal biopsies were included, with a total of 116 biopsies.


RESULTS
Of the 71 repeat biopsies, pathological transition occurred in 39 (54.9%). When having a previous biopsy with a proliferative lesion, class switch occurred in 55.6%, with 24.4% evolving into non-proliferative classes. When previous biopsy was class V, transition to other classes occurred in 58.3% and changes were all into proliferative classes. Conversion from one pure proliferative form to another (class III to class IV or vice versa) happened in 11.3% of the rebiopsies, with 62 rebiopsies (87.3%) leading to a change in the treatment regimen.


CONCLUSIONS
Histological transformations were common, and they occurred when the previous biopsy had non-proliferative lesions as well as when lesions were proliferative. Treatments were modified after repeat renal biopsy in the majority of patients. In this experience, kidney repeat biopsies were useful in guiding treatment of LN flares.
Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
G
G
Greloni
Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina.
M
M
Scolnik
Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina.
J
J
Marin
Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina.
E
E
Lancioni
Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina.
C
C
Quiroz
Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina.
J
J
Zacariaz
Pathology Department , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
P
P
De la Iglesia Niveyro
Pathology Department , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
S
S
Christiansen
Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
M A
MA
Pierangelo
Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
C F
CF
Varela
Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina.
G J
GJ
Rosa-Diez
Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina.
L J
LJ
Catoggio
Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina.
E R
ER
Soriano
Lupus Nephritis; Outcomes Research; Systemic Lupus Erythematosus