Division of Nephrology, Nanfang Hospital, Southern Medical University, Key Lab for Organ Failure Research, Ministry of Education, Guangzhou, Guangdong 510515, China.
Chin Med J (Engl). 2012 Aug;125(16):2890-4.
Relapses occur frequently in patients with lupus nephritis. Renal biopsy is the gold standard for assessing renal activity and hence guiding the treatment. Whether repeat renal biopsy is helpful during flares of lupus nephritis remains inconclusive. In the present study, we retrospectively reviewed the patients with lupus nephritis who had more than one renal biopsy with the hope to find the clinical value of repeat biopsy.
Patients who had a diagnosis of lupus nephritis and two or more renal biopsies were selected from the database of the patient pathology registration at this renal division. Renal biopsy was evaluated according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis. The pathological patterns and treatment regimens were analyzed after a repeat biopsy.
We identified 44 systemic lupus erythematosus patients with serial renal biopsies. In total, there were 94 renal biopsies. Overall, the pathological transition occurred in 64% instances according to the ISN/RPS class. When the transition was analyzed according to proliferative, membranous or mix lesions, it showed different profile: 35% in patients with proliferative lesion, 23.5% patients with mix lesions, 100% in patients with pure membranous lesion. The pathological transition could not be predicted by any clinical characteristics. After the repeat renal biopsy, 34% of patients had a change in their treatment regimens.
The pathological conversion was very prevalent in patients with lupus nephritis. However, the transitions became less prevalent when they were analyzed according to pure membranous, proliferative, and mix lesion. Repeat biopsy might be helpful to avoid unnecessary increased immunosuppression therapy.
狼疮肾炎患者常出现复发。肾活检是评估肾脏活动度并指导治疗的金标准。狼疮肾炎发作时是否需要重复肾活检尚无定论。本研究回顾性分析了多次肾活检的狼疮肾炎患者，以期发现重复肾活检的临床价值。
从本肾内科患者病理登记数据库中筛选出诊断为狼疮肾炎且有 2 次或以上肾活检的患者。根据国际肾脏病学会/肾脏病理学会（ISN/RPS）狼疮肾炎分类对肾活检进行评估。对重复肾活检后的病理模式和治疗方案进行分析。
共纳入 44 例系统性红斑狼疮患者，均有连续肾活检，共 94 次。总体而言，根据 ISN/RPS 分级，64%的病例出现病理转变。按增生性、膜性或混合病变分析转变，其特征不同：增生性病变患者中 35%、混合病变患者中 23.5%、单纯膜性病变患者中 100%出现转变。病理转变不能由任何临床特征预测。重复肾活检后，34%的患者治疗方案发生改变。
狼疮肾炎患者的病理转变非常普遍。然而，当按单纯膜性、增生性和混合病变进行分析时，转变的发生率较低。重复肾活检可能有助于避免不必要的免疫抑制治疗增加。
