Comparison Study on the Effect of Treatment Decision Based on Renal Biopsy and Clinical Symptoms in the Outcome of Patients with Recurrent Lupus Nephritis

Karimzadeh, Hadi; Hasani, Shokrollah; Sayedbonakdar, Zahra; Koushki, Ali Mehrabi

Comparison Study on the Effect of Treatment Decision Based on Renal Biopsy and Clinical Symptoms in the Outcome of Patients with Recurrent Lupus Nephritis

Document Type : Original Article

Authors

¹ Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran

² Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Renal involvement in systemic lupus erythematous is one of the most serious complications. The aim of this study was to compare the effects of treatment decisions based on clinical symptoms and renal biopsy on the outcome of patients with recurrent lupus nephritis. Materials and Methods: This descriptive study was conducted in 2012–13 in the Alzahra hospital on patients with lupus nephritis who had referred to the rheumatology clinic of this center due to lupus nephritis relapse. All lupus nephritis patients were diagnosed with renal biopsy and had gone into remission by treatment but due to the discontinuation of treatment and other causes had relapsed. The patients were divided randomly into two groups of 26, the first group was treated without renal biopsy and based on clinical and laboratory symptoms and the second group was re-biopsied through considering the ethical points. Then their relationship with laboratory findings (BUN, Cr, ANA, ds-DNA, C3, C4, CH50, U/A, cast, and proteinuria), treatment and recurrence outcome were compared between the two groups. Results: The mean of SLEDAI-2K index before initial treatment, after the first round of treatment and after the second round of treatment in single biopsy group and twice biopsy group is not significantly different (P = 0.27). Conclusions: Treatment decisions based on clinical and laboratory findings or re-biopsy of the kidney in patients who relapsed after initial treatment had no significant effect on the recovery of patients. Adoption of a treatment plan in patients with lupus nephritis is recommended based on clinical and laboratory finding and the discretion of the physician and if possible, kidney re-biopsy should be avoided.

Keywords

References

1.	Dooley MA, Aranow C, Ginzler EM. Review of ACR renal criteria in systemic lupus erythematosus. Lupus 2004;13:857-60.
2.	Kasitanon N, Magder LS, Petri M. Predictors of survival in systemic lupus erythematosus. Medicine (Baltimore) 2006;85:147-56.
3.	Ward MM, Pyun E, Studenski S. Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus. Arch Intern Med 1996;156:1337-44.
4.	Alarcón GS, McGwin G Jr, Petri M, Reveille JD, Ramsey-Goldman R, Kimberly RP; PROFILE Study Group. Baseline characteristics of a multiethnic lupus cohort: PROFILE. Lupus 2002;11:95-101.
5.	Bihl GR, Petri M, Fine DM. Kidney biopsy in lupus nephritis: Look before you leap. Nephrol Dial Transplant 2006;21:1749-52.
6.	Gladman DD, Urowitz MB, Cole E, Ritchie S, Chang CH, Churg J. Kidney biopsy in SLE: I. A clinical-morphologic evaluation. Q J Med 1989;73:1125-33.
7.	Nossent JC, Henzen-Logmans SC, Vroom TM, Huysen V, Berden JH, Swaak AJ. Relation between serological data at the time of biopsy and renal histology in lupus nephritis. Rheumatol Int 1991;11:77-82.
8.	Hsieh YP, Wen YK, Chen ML. The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement. Clin Nephrol 2012;77:18-24.
9.	Sidiropoulos PI, Kritikos HD, Boumpas DT. Lupus nephritis flares. Lupus 2005;14:49-52.
10.	Daleboudt GM, Bajema IM, Goemaere NN, van Laar JM, Bruijn JA, Berger SP. The clinical relevance of a repeat biopsy in lupus nephritis flares. Nephrol Dial Transplant 2009;24:3712-7.
11.	Bajaj S, Albert L, Gladman DD, Urowitz MB, Hallett DC, Ritchie S. Serial renal biopsy in systemic lupus erythematosus. J Rheumatol 2000;27:2822-6.
12.	Esdaile JM, Joseph L, MacKenzie T, Kashgarian M, Hayslett JP. The pathogenesis and prognosis of lupus nephritis: Information from repeat renal biopsy. Semin Arthritis Rheum 1993;23:135-48.
13.	Lee HS, Mujais SK, Kasinath BS, Spargo BH, Katz AI. Course of renal pathology in patients with systemic lupus erythematosus. Am J Med 1984;77:612-20.
14.	Moroni G, Pasquali S, Quaglini S, Banfi G, Casanova S, Maccario M, et al. Clinical and prognostic value of serial renal biopsies in lupus nephritis. Am J Kidney Dis 1999;34:530-9.
15.	Sloan RP, Schwartz MM, Korbet SM, Borok RZ. Long-term outcome in systemic lupus erythematosus membranous glomerulonephritis. Lupus Nephritis Collaborative Study Group. J Am Soc Nephrol 1996;7:299-305.
16.	Renal Disease Subcommittee of the American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Response Criteria. The American College of Rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials. Arthritis Rheum 2006;54:421-32.
17.	Moroni G, Quaglini S, Maccario M, Banfi G, Ponticelli C. “Nephritic flares” are predictors of bad long-term renal outcome in lupus nephritis. Kidney Int 1996;50:2047-53.
18.	Wiener C, Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's principles of internal medicine, self-assessment and board review. McGraw Hill Professional; 2008 Jul 20.
19.	Huong DL, Papo T, Beaufils H, Wechsler B, Blétry O, Baumelou A, et al. Renal involvement in systemic lupus erythematosus. A study of 180 patients from a single center. Medicine (Baltimore) 1999;78:148-66.
20.	Wang GB, Xu ZJ, Liu HF, Zhou QG, Zhou ZM, Jia N. Changes in pathological pattern and treatment regimens based on repeat renal biopsy in lupus nephritis. Chin Med J (Engl) 2012;125:2890-4.
21.	Rezaeieyazdi Z, Ghareh S, Ghaffarzadegan K, Maboodi A, Maboodi A. Correlation between histological findings, activity & choronicity indices and laboratory data in patients with lupus nephritis. JQUMS, 2010;14:5-11.

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