Lupus & antiphospholipid syndrome
Role of repeat kidney biopsy after 6 months of treatment in proliferative lupus nephritis
Authors' conclusion
In this real-world cohort of proliferative LN, substantial discordance between clinical and histological response was observed following induction therapy. While histological activity improved in most patients, chronic damage progressed in half of the cohort despite favourable clinical evolution.
Study context
- Population
- Adults with SLE and biopsy-proven proliferative lupus nephritis (LN) undergoing protocolised repeat kidney biopsy at 6 months (±3 months) after induction therapy
- Participants
- 20 adults
- Outcome
- Histological response following induction therapy
- Follow-up
- 6 months (±3 months)
Methodological detailsobservational, per-protocol repeat kidney biopsy, real-world cohort
- Observational
- Per-protocol repeat kidney biopsy
- Real-world cohort
Main finding
As reported in the abstract
Histological activity index (AI) decreased significantly; improvement in % of patients
90%
CI increased, not statistically significant; % of patients
50%
Histological response at 6 months
45%
Observational data: associations, not effects.
Further findings
Primary efficacy renal response (clinical) · 6 months
- Achieved primary efficacy renal response
- 55%
Clinical-histological discordance · 6 months
- Clinical responders with persistent histological activity
- 45%
- Histological responders not meeting clinical response criteria
- 33%
Clinical and laboratory changes · median of 7.5 months
- Proteinuria significantly decreased; eGFR and complement levels significantly improved
Baseline factors associated with histological change
- Lower baseline proteinuria and better baseline renal function among patients with AI improvement
- Patients with CI increase had lower baseline CI and tended to better baseline renal function
- Histological outcomes did not differ by type of induction immunosuppressive therapy
Original publication
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