title: Practice patterns and approach to kidney biopsy in lupus: a collaboration of the Midwest Pediatric Nephrology Consortium and the Childhood Arthritis and Rheumatology Research Alliance.
abstract: BACKGROUND
  There is no clear consensus regarding optimal indications or timing of initial or repeat kidney biopsy in the management of pediatric systemic lupus erythematosus (pSLE).
  
  
  METHODS
  A web-based survey was designed to assess current practice patterns among pediatric nephrologists and pediatric rheumatologists and distributed to members of Midwest Pediatric Nephrology Consortium (MWPNC) and Childhood Arthritis and Rheumatology Research Alliance (CARRA).
  
  
  RESULTS
  Respondents included 111 rheumatologists and 71 nephrologists from 65 and 34 centers, respectively. Numbers of years in sub-specialty practice were comparable. Rheumatologists and nephrologists frequently collaborate in the care of children with lupus nephritis (LN). More than 90% of respondents refer patients to each either other after diagnosing LN. Over 60% describe shared decision making regarding when to perform kidney biopsy and how to interpret biopsy findings. Many pediatric nephrologists consider biopsy to be of higher risk for complication in pSLE and alter their standard pre-or post-biopsy management.
  
  
  CONCLUSIONS
  It is uncommon for pediatric nephrologists to manage LN without input from pediatric rheumatologists and vice versa. Consensus exists between specialties in general, and practice differences that exist occur between individual physicians rather than between specialties. A systematic approach to biopsy may result in improved health related outcomes in pSLE.
authors.affiliation: Pediatric Nephrology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. wenderfe@bcm.edu.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Wenderfer
authors.affiliation: Pediatric Nephrology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. j-lane@northwestern.edu.
authors.forename: Jerome C
authors.initials: JC
authors.lastname: Lane
authors.affiliation: Pediatric Nephrology, Medical University of South Carolina Children's Hospital, Charleston, SC, USA. shatat@musc.edu.
authors.forename: Ibrahim F
authors.initials: IF
authors.lastname: Shatat
authors.affiliation: Pediatric Rheumatology, University of California San Francisco, San Francisco, CA, USA. evonsche@peds.ucsf.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: von Scheven
authors.affiliation: Pediatric Rheumatology, Medical University of South Carolina Children's Hospital, Charleston, SC, USA. ruthn@musc.edu.
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Ruth
mesh_terms: D001706:Biopsy; D002648:Child; D003299:Cooperative Behavior; D003625:Data Collection; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D015146:Midwestern United States; D009393:Nephritis / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D009398:Nephrology; D010818:Practice Patterns, Physicians'; D012219:Rheumatology; D012955:Societies, Medical; D013038:Specialization