title: Histologic versus clinical remission in proliferative lupus nephritis.
abstract: BACKGROUND
  Treatment response in lupus nephritis (LN) is defined clinically, without consideration of renal histology. Few studies have systematically examined histologic responses to induction therapy. In LN patients who underwent protocol kidney biopsies after induction immunosuppression, we describe the renal histology of the second biopsy and correlate histologic activity and damage with short- and long-term kidney outcomes.
  
  
  METHODS
  Patients with suspected LN were biopsied for diagnosis (Biopsy 1), and those with proliferative LN were rebiopsied after induction (Biopsy 2). Histologic activity and damage at each biopsy were calculated as the National Institutes of Health activity and chronicity indices. Complete and partial renal responses after induction and after long-term follow-up were determined clinically.
  
  
  RESULTS
  One-third of patients who achieved a complete clinical response after induction had persistently high histologic activity, and 62% of patients who had complete histologic remission on rebiopsy were still clinically active. Chronic renal damage increased after induction even in complete clinical responders. Chronicity at Biopsy 2 associated with long-term kidney function and development of chronic kidney disease.
  
  
  CONCLUSIONS
  Early clinical and histologic outcomes are discordant in proliferative LN, and neither correlates with long-term renal outcome. The kidney accrues chronic damage rapidly and despite clinical response in LN. Preservation of kidney function may require therapeutic targeting of both chronic damage and inflammation during LN induction treatment.
authors.affiliation: Hospital Fernandez, Buenos Aires, Argentina.
authors.forename: Ana
authors.initials: A
authors.lastname: Malvar
authors.affiliation: Hospital Fernandez, Buenos Aires, Argentina.
authors.forename: Paola
authors.initials: P
authors.lastname: Pirruccio
authors.affiliation: Hospital Fernandez, Buenos Aires, Argentina.
authors.forename: Valeria
authors.initials: V
authors.lastname: Alberton
authors.affiliation: Hospital Fernandez, Buenos Aires, Argentina.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lococo
authors.affiliation: Hospital Fernandez, Buenos Aires, Argentina.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Recalde
authors.affiliation: Hospital Fernandez, Buenos Aires, Argentina.
authors.forename: Bernanda
authors.initials: B
authors.lastname: Fazini
authors.affiliation: College of Public Health, Ohio State University, Columbus, OH, USA.
authors.forename: Haikady
authors.initials: H
authors.lastname: Nagaraja
authors.affiliation: Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Divya
authors.initials: D
authors.lastname: Indrakanti
authors.affiliation: Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Brad H
authors.initials: BH
authors.lastname: Rovin
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008181:Lupus Nephritis / Q000150:complications* / Q000628:therapy; D008297:Male; D012074:Remission Induction; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000473:pathology* / Q000601:surgery
keywords: activity index; chronicity index; kidney biopsy; lupus nephritis; outcomes