PMID- 32353879
OWN - NLM
STAT- MEDLINE
DCOM- 20210201
LR  - 20210201
IS  - 1462-0332 (Electronic)
IS  - 1462-0324 (Linking)
VI  - 59
IP  - 11
DP  - 2020 Nov 1
TI  - Per-protocol repeat kidney biopsy portends relapse and long-term outcome in 
      incident cases of proliferative lupus nephritis.
PG  - 3424-3434
LID - 10.1093/rheumatology/keaa129 [doi]
AB  - OBJECTIVES: In patients with LN, clinical and histological responses to treatment 
      have been shown to be discordant. We investigated whether per-protocol repeat 
      kidney biopsies are predictive of LN relapses and long-term renal function 
      impairment. METHODS: Forty-two patients with incident biopsy-proven active 
      proliferative (class III/IV+/-V) LN from the database of the UCLouvain were 
      included in this retrospective study. Per-protocol repeat biopsies were performed 
      after a median [interquartile range (IQR)] time of 24.3 (21.3-26.2) months. The 
      National Institutes of Health activity index (AI) and chronicity index (CI) 
      scores were assessed in all biopsies. RESULTS: Despite a moderate correlation 
      between urinary protein/creatinine ratios (UPCR) and AI scores at repeat biopsy 
      (r = 0.48; P = 0.001), 10 patients (23.8%) with UPCR < 1.0 g/g still had a high 
      degree of histological activity (AI > 3). High AI scores (continuous) in repeat 
      biopsies were associated with an increased probability and/or shorter time to 
      renal relapse (n = 11) following the repeat biopsy [hazard ratio (HR) = 1.2, 95% 
      CI: 1.1, 1.3; P = 0.007], independently of proteinuria levels. High CI scores 
      (continuous) in repeat biopsies were associated with a sustained increase in 
      serum creatinine levels corresponding to >/=120% of the baseline value (HR = 1.8, 
      95% CI: 1.1, 2.9; P = 0.016) through a median (IQR) follow-up time of 131.5 
      (73.8-178.2) months, being also the case for acute tubulointerstitial 
      inflammation and interstitial fibrosis/tubular atrophy in repeat but not baseline 
      biopsies. CONCLUSION: Our results highlight the usefulness of per-protocol repeat 
      biopsies, herein performed after a median time of 24 months from baseline, as an 
      integral part of the treatment evaluation, also in patients showing adequate 
      clinical response.
CI  - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the 
      British Society for Rheumatology. All rights reserved. For permissions, please 
      email: journals.permissions@oup.com.
FAU - Parodis, Ioannis
AU  - Parodis I
AD  - Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and 
      Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
FAU - Adamichou, Christina
AU  - Adamichou C
AD  - Rheumatology Department, Cliniques Universitaires Saint-Luc and Pole de 
      Pathologies Rhumatismales Inflammatoires et Systemiques, Institut de Recherche 
      Experimentale et Clinique, Universite catholique de Louvain.
FAU - Aydin, Selda
AU  - Aydin S
AD  - Pathology Department, Cliniques Universitaires Saint-Luc.
FAU - Gomez, Alvaro
AU  - Gomez A
AD  - Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and 
      Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
FAU - Demoulin, Nathalie
AU  - Demoulin N
AD  - Division of Nephrology, Cliniques Universitaires Saint-Luc and Institut de 
      Recherche Experimentale et Clinique, Universite catholique de Louvain, Brussels, 
      Belgium.
FAU - Weinmann-Menke, Julia
AU  - Weinmann-Menke J
AD  - Department of Nephrology, Rheumatology and Clinical Immunology, University 
      Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
FAU - Houssiau, Frederic A
AU  - Houssiau FA
AD  - Rheumatology Department, Cliniques Universitaires Saint-Luc and Pole de 
      Pathologies Rhumatismales Inflammatoires et Systemiques, Institut de Recherche 
      Experimentale et Clinique, Universite catholique de Louvain.
FAU - Tamirou, Farah
AU  - Tamirou F
AD  - Rheumatology Department, Cliniques Universitaires Saint-Luc and Pole de 
      Pathologies Rhumatismales Inflammatoires et Systemiques, Institut de Recherche 
      Experimentale et Clinique, Universite catholique de Louvain.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Glucocorticoids)
RN  - 0 (Immunologic Factors)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 8N3DW7272P (Cyclophosphamide)
RN  - AYI8EX34EU (Creatinine)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - IM
MH  - Adult
MH  - Biopsy
MH  - Creatinine/urine
MH  - Cyclophosphamide/therapeutic use
MH  - Disease Progression
MH  - Female
MH  - Glucocorticoids/therapeutic use
MH  - Humans
MH  - Immunologic Factors/therapeutic use
MH  - Immunosuppressive Agents/therapeutic use
MH  - Kidney/*pathology
MH  - Kidney Tubules/pathology
MH  - Lupus Nephritis/drug therapy/*pathology/urine
MH  - Male
MH  - Methylprednisolone/therapeutic use
MH  - Mycophenolic Acid/therapeutic use
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Proteinuria/urine
MH  - Pulse Therapy, Drug
MH  - Recurrence
MH  - Retrospective Studies
MH  - Rituximab/therapeutic use
MH  - Young Adult
OTO - NOTNLM
OT  - histopathology
OT  - long-term outcome
OT  - lupus nephritis
OT  - renal biopsy
OT  - renal function
OT  - repeat biopsy
OT  - systemic lupus erythematosus
EDAT- 2020/05/01 06:00
MHDA- 2021/02/02 06:00
CRDT- 2020/05/01 06:00
PHST- 2019/11/26 00:00 [received]
PHST- 2020/02/24 00:00 [revised]
PHST- 2020/05/01 06:00 [pubmed]
PHST- 2021/02/02 06:00 [medline]
PHST- 2020/05/01 06:00 [entrez]
AID - 5827514 [pii]
AID - 10.1093/rheumatology/keaa129 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2020 Nov 1;59(11):3424-3434. doi: 
      10.1093/rheumatology/keaa129.