Strategy for second kidney biopsy in patients with lupus nephritis
Standard clinical and laboratory parameters have limited predictive values for discriminating between active lupus nephritis and chronic disease. The objective of this study was to examine the predictive utility of a second kidney biopsy in patients with lupus nephritis. Patients with lupus nephriti...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2012-04, Vol.27 (4), p.1472-1478 |
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| creator | ALSUWAIDA, Abdulkareem HUSAIN, Sufia ALGHONAIM, Mohammed ALOUDAH, Noura ALWAKEEL, Jamal ULLAH, Anhar KFOURY, Hala |
| description | Standard clinical and laboratory parameters have limited predictive values for discriminating between active lupus nephritis and chronic disease. The objective of this study was to examine the predictive utility of a second kidney biopsy in patients with lupus nephritis.
Patients with lupus nephritis were advised to have second kidney biopsies at the end of the maintenance phase of their therapies. Baseline and second renal biopsies were re-classified by pathologists blinded to the clinical data. The relationships between remission status and histological parameters were examined.
Included in this study were 77 patients followed up for a median duration of 8.7 years (interquartile range, 5.3-10.1 years). Their renal survival rates were 93% for those in complete remission (CR), 69% for partial remission (PR) and 41% for no remission (NR). One-third of the patients with PR and 14% of patients with NR had no histological evidence of active disease on second biopsy. At the second biopsy, but not at the baseline biopsy, activity index was predictive of survival. The 10-year renal survival rate was 100% for those with an activity index of 0, 80% for those with an activity index of 1 or 2 on the second biopsy and 44% for those with an index of >2, regardless of remission status.
Second kidney biopsy at the end of maintenance phase of therapy is an important diagnostic and prognostic tool that could guide physicians to safer practices with better outcomes. |
| doi_str_mv | 10.1093/ndt/gfr517 |
| format | Article |
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Patients with lupus nephritis were advised to have second kidney biopsies at the end of the maintenance phase of their therapies. Baseline and second renal biopsies were re-classified by pathologists blinded to the clinical data. The relationships between remission status and histological parameters were examined.
Included in this study were 77 patients followed up for a median duration of 8.7 years (interquartile range, 5.3-10.1 years). Their renal survival rates were 93% for those in complete remission (CR), 69% for partial remission (PR) and 41% for no remission (NR). One-third of the patients with PR and 14% of patients with NR had no histological evidence of active disease on second biopsy. At the second biopsy, but not at the baseline biopsy, activity index was predictive of survival. The 10-year renal survival rate was 100% for those with an activity index of 0, 80% for those with an activity index of 1 or 2 on the second biopsy and 44% for those with an index of >2, regardless of remission status.
Second kidney biopsy at the end of maintenance phase of therapy is an important diagnostic and prognostic tool that could guide physicians to safer practices with better outcomes.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfr517</identifier><identifier>PMID: 21931127</identifier><identifier>CODEN: NDTREA</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Biopsy ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Follow-Up Studies ; Humans ; Intensive care medicine ; Kidney - pathology ; Kidney - surgery ; Kidney Diseases - etiology ; Kidney Diseases - mortality ; Kidney Diseases - prevention & control ; Kidney Function Tests ; Lupus Nephritis - complications ; Lupus Nephritis - therapy ; Male ; Medical sciences ; Predictive Value of Tests ; Remission Induction ; Reoperation ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Survival Rate</subject><ispartof>Nephrology, dialysis, transplantation, 2012-04, Vol.27 (4), p.1472-1478</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-a0bda5860ea0eeb2efa0402f559b06339b2283b6b888e78cfd58657a724ddc23</citedby><cites>FETCH-LOGICAL-c352t-a0bda5860ea0eeb2efa0402f559b06339b2283b6b888e78cfd58657a724ddc23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25703149$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21931127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ALSUWAIDA, Abdulkareem</creatorcontrib><creatorcontrib>HUSAIN, Sufia</creatorcontrib><creatorcontrib>ALGHONAIM, Mohammed</creatorcontrib><creatorcontrib>ALOUDAH, Noura</creatorcontrib><creatorcontrib>ALWAKEEL, Jamal</creatorcontrib><creatorcontrib>ULLAH, Anhar</creatorcontrib><creatorcontrib>KFOURY, Hala</creatorcontrib><title>Strategy for second kidney biopsy in patients with lupus nephritis</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Standard clinical and laboratory parameters have limited predictive values for discriminating between active lupus nephritis and chronic disease. The objective of this study was to examine the predictive utility of a second kidney biopsy in patients with lupus nephritis.
Patients with lupus nephritis were advised to have second kidney biopsies at the end of the maintenance phase of their therapies. Baseline and second renal biopsies were re-classified by pathologists blinded to the clinical data. The relationships between remission status and histological parameters were examined.
Included in this study were 77 patients followed up for a median duration of 8.7 years (interquartile range, 5.3-10.1 years). Their renal survival rates were 93% for those in complete remission (CR), 69% for partial remission (PR) and 41% for no remission (NR). One-third of the patients with PR and 14% of patients with NR had no histological evidence of active disease on second biopsy. At the second biopsy, but not at the baseline biopsy, activity index was predictive of survival. The 10-year renal survival rate was 100% for those with an activity index of 0, 80% for those with an activity index of 1 or 2 on the second biopsy and 44% for those with an index of >2, regardless of remission status.
Second kidney biopsy at the end of maintenance phase of therapy is an important diagnostic and prognostic tool that could guide physicians to safer practices with better outcomes.</description><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Kidney - pathology</subject><subject>Kidney - surgery</subject><subject>Kidney Diseases - etiology</subject><subject>Kidney Diseases - mortality</subject><subject>Kidney Diseases - prevention & control</subject><subject>Kidney Function Tests</subject><subject>Lupus Nephritis - complications</subject><subject>Lupus Nephritis - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Predictive Value of Tests</subject><subject>Remission Induction</subject><subject>Reoperation</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Survival Rate</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpF0EtLAzEUhuEgitbqxh8g2YggjM2lmWSWWrxBwYXdD7m20WlmTDLI_HtHWnV1FufhW7wAXGB0i1FFZ8Hk2dpFhvkBmOB5iQpCBTsEk_GJC8RQdQJOU3pHCFWE82NwQvD4wYRPwP1bjjLb9QBdG2Gyug0GfngT7ACVb7s0QB9gJ7O3ISf45fMGNn3XJxhst4k--3QGjpxskj3f3ylYPT6sFs_F8vXpZXG3LDRlJBcSKSOZKJGVyFpFrJNojohjrFKopLRShAiqSiWEsFxoZ0bMuORkbowmdAqud7NdbD97m3K99UnbppHBtn2qq5IKSsuyGuXNTurYphStq7votzIONUb1T7F6LFbvio34cj_bq601f_Q30Qiu9kAmLRsXZdA-_TvGEcXzin4DToR1BQ</recordid><startdate>20120401</startdate><enddate>20120401</enddate><creator>ALSUWAIDA, Abdulkareem</creator><creator>HUSAIN, Sufia</creator><creator>ALGHONAIM, Mohammed</creator><creator>ALOUDAH, Noura</creator><creator>ALWAKEEL, Jamal</creator><creator>ULLAH, Anhar</creator><creator>KFOURY, Hala</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120401</creationdate><title>Strategy for second kidney biopsy in patients with lupus nephritis</title><author>ALSUWAIDA, Abdulkareem ; HUSAIN, Sufia ; ALGHONAIM, Mohammed ; ALOUDAH, Noura ; ALWAKEEL, Jamal ; ULLAH, Anhar ; KFOURY, Hala</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-a0bda5860ea0eeb2efa0402f559b06339b2283b6b888e78cfd58657a724ddc23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Kidney - pathology</topic><topic>Kidney - surgery</topic><topic>Kidney Diseases - etiology</topic><topic>Kidney Diseases - mortality</topic><topic>Kidney Diseases - prevention & control</topic><topic>Kidney Function Tests</topic><topic>Lupus Nephritis - complications</topic><topic>Lupus Nephritis - therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Predictive Value of Tests</topic><topic>Remission Induction</topic><topic>Reoperation</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ALSUWAIDA, Abdulkareem</creatorcontrib><creatorcontrib>HUSAIN, Sufia</creatorcontrib><creatorcontrib>ALGHONAIM, Mohammed</creatorcontrib><creatorcontrib>ALOUDAH, Noura</creatorcontrib><creatorcontrib>ALWAKEEL, Jamal</creatorcontrib><creatorcontrib>ULLAH, Anhar</creatorcontrib><creatorcontrib>KFOURY, Hala</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>ALSUWAIDA, Abdulkareem</au><au>HUSAIN, Sufia</au><au>ALGHONAIM, Mohammed</au><au>ALOUDAH, Noura</au><au>ALWAKEEL, Jamal</au><au>ULLAH, Anhar</au><au>KFOURY, Hala</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Strategy for second kidney biopsy in patients with lupus nephritis</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>27</volume><issue>4</issue><spage>1472</spage><epage>1478</epage><pages>1472-1478</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><coden>NDTREA</coden><abstract>Standard clinical and laboratory parameters have limited predictive values for discriminating between active lupus nephritis and chronic disease. The objective of this study was to examine the predictive utility of a second kidney biopsy in patients with lupus nephritis.
Patients with lupus nephritis were advised to have second kidney biopsies at the end of the maintenance phase of their therapies. Baseline and second renal biopsies were re-classified by pathologists blinded to the clinical data. The relationships between remission status and histological parameters were examined.
Included in this study were 77 patients followed up for a median duration of 8.7 years (interquartile range, 5.3-10.1 years). Their renal survival rates were 93% for those in complete remission (CR), 69% for partial remission (PR) and 41% for no remission (NR). One-third of the patients with PR and 14% of patients with NR had no histological evidence of active disease on second biopsy. At the second biopsy, but not at the baseline biopsy, activity index was predictive of survival. The 10-year renal survival rate was 100% for those with an activity index of 0, 80% for those with an activity index of 1 or 2 on the second biopsy and 44% for those with an index of >2, regardless of remission status.
Second kidney biopsy at the end of maintenance phase of therapy is an important diagnostic and prognostic tool that could guide physicians to safer practices with better outcomes.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21931127</pmid><doi>10.1093/ndt/gfr517</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Biopsy Emergency and intensive care: renal failure. Dialysis management Female Follow-Up Studies Humans Intensive care medicine Kidney - pathology Kidney - surgery Kidney Diseases - etiology Kidney Diseases - mortality Kidney Diseases - prevention & control Kidney Function Tests Lupus Nephritis - complications Lupus Nephritis - therapy Male Medical sciences Predictive Value of Tests Remission Induction Reoperation Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Survival Rate |
| title | Strategy for second kidney biopsy in patients with lupus nephritis |
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