PT  - JOURNAL ARTICLE
AU  - G Greloni
AU  - M Scolnik
AU  - J Marin
AU  - E Lancioni
AU  - C Quiroz
AU  - J Zacariaz
AU  - P De la Iglesia Niveyro
AU  - S Christiansen
AU  - M A Pierangelo
AU  - C F Varela
AU  - G J Rosa-Diez
AU  - L J Catoggio
AU  - E R Soriano
TI  - Value of repeat biopsy in lupus nephritis flares
AID  - 10.1136/lupus-2013-000004
DP  - 2014 Apr 01
TA  - Lupus Science & Medicine
PG  - e000004
VI  - 1
IP  - 1
4099  - http://lupus.bmj.com/content/1/1/e000004.short
4100  - http://lupus.bmj.com/content/1/1/e000004.full
SO  - Lupus Sci & Med2014 Apr 01; 1
AB  - Objectives 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.