Renal Biopsy andRebiopsy in Lupus Nephritis

Overview

Renal biopsy is irreplaceable in the diagnosis, and in particular treatment of patients with lupusnephritis. So far none of the clinical or laboratory parameters can be used to predict the histologicalfinding and in particular the extent of lesions. Biopsy makes a correct definite diagnosis of the renalinvolvement in SLE possible as well as indication of appropriate treatment. Immunosuppressivetreatment based on knowledge of renal histology contributes also, beyond doubt, to a betterprognosis of lupus nephritis. On the other hand the role and indication for renal rebiopsy in patientswith lupus nephritis is a problem for which there is not yet a definite answer. Careful clinicalfollow-up and intense laboratory monitoring usually permit early and aggressive treatment of renalrelapses of the disease characterized by a rise of serum creatinine or proteinuria; however onlyrepeated renal biopsies permit evaluation of the long-term prognosis incl. important therapeuticdecisions in every given case. A good correlation between the clinical picture and histologicalfinding is usually encountered in patients whose condition has improved. An unaltered histologicalfinding is usual in patients with persisting nephrotic syndrome. Conversely in patients withdeteriorating renal function the histological finding cannot be predicted. In particular in thesepatients who run the risk of development of irreversible renal failure renal rebiopsy is not only fullyindicated but more or less mandatory to evaluate the necessity or suitability of further aggressivetreatment.

Key words:
systemic lupus erythematosus, biopsy, glomerulonephritis, lupus nephritis