LUPUS NEPHRITIS - PREDICTIVE VALUE OF CONVENTIONAL AND DOPPLER US ANDCOMPARISON WITH SEROLOGIC AND BIOPSY PARAMETERS

PURPOSE: To compare conventional and Doppler ultrasound (US) with clin ical and biopsy parameters used to assess disease activity and outcome in lupus nephritis and to assess the predictive value of US. MATERIAL S AND METHODS: Thirty-four patients with lupus nephritis prospectively underwent laboratory and US analysis at the time of renal biopsy. US parameters were renal length, relative echogenicity, and resistive ind ex (RI). Laboratory parameters were serum creatinine level, urinary pr otein level, and serum markers of disease activity. Biopsy parameters were activity index, chronicity index, and assessment of the tubuloint erstitium of the kidney. Follow-up data were obtained in all patients for at least 1 year. RESULTS: Ten patients with elevated RI (> 0.70) h ad significantly (P < .05) higher chronicity indexes and creatinine le vels than the 24 patients with a more normal RI. RI correlated signifi cantly (P < .05) with creatinine level, chronicity index, and presence of interstitial disease. Only RI and chronicity index were statistica lly significant predictors of a poor renal outcome. Abnormalities at c onventional US were not predictive of renal outcome. A normal RI predi cted a better renal outcome whether or not creatinine level was elevat ed. CONCLUSION: Renal Doppler US may be of greatest clinical utility w hen its results are apparently discordant with renal functional assess ment by allowing identification of patients with higher likelihood of subsequent improvement or worsening of renal status.