Clinical and prognostic value of serial renal biopsies in lupus nephritis

Little information is available about the role of repeated renal biopsies i n lupus nephritis. We analyzed retrospectively the prognostic significance of serial renal biopsies in patients with lupus nephritis. Thirty-one patie nts with lupus nephritis underwent two or more renal biopsies during follow -up. The Indications for repeated biopsy were as follows: improvement of re nal disease but persistence of nonnephrotic proteinuria (group A, 7 patient s); persistent or relapsing nephrotic syndrome (group B, 12 patients); and worsening of renal function (group C, 19 patients). After a median follow-u p of 10.5 years, 17 patients reached the end point (persistent doubling of plasma creatinine level). At repeated renal biopsy, there was a correlation between improved clinical and histological features for group A. In these patients, treatment was reduced or stopped successfully. Histological featu res remained almost unchanged in group B. All patients showed an improvemen t of proteinuria after reinforcement of therapy. In group C, the worsening of renal function was associated with a variable and clinically unpredictab le combination of active and chronic lesions. Only the few patients with an elevated activity index and moderate chronicity index showed a favorable a nd persistent improvement of renal disease after reinforcement of therapy. At multivariate analysis of clinical and histological data at presentation, only male sex was predictive of an adverse outcome (P = 0.015). At repeate d renal biopsy, crescents in more than 30% of glomeruli (P = 0.0009) and ch ronicity index of 5 or greater (P = 0.00006) were associated with the proba bility of reaching the end point at multivariate analysis. Repeated renal b iopsy may be helpful for establishing the prognosis in patients with lupus nephritis, particularly in the presence of worsening of renal function. (C) 1999 by the National Kidney Foundation, Inc.