Biopsia renal seriada en nefropatía lúpica: ¿es necesaria?

Abstract

Introduction and objectives

Lupus nephritis continues to be the most common cause of renal failure of autoimmune origin that requires dialysis in our region. There is limited information available on the role of serial biopsies in lupus nephritis. Our objective was to compare the renal function of patients with lupus nephritis with a repeated renal biopsy at one year, with patients without a repeated biopsy.

Methods

A longitudinal, retrospective, observational and comparative analysis study was conducted on patients with lupus nephritis with at least one renal biopsy between January 2004 and January 2012.

Results

Of the 100 patients included with lupus nephritis, 57 of them had a repeated biopsy, and 43 had no repeated biopsy. The group without a repeated biopsy had a higher percentage of patients with declining renal function (58.1% vs. 41.9%) and a higher percentage of patients on dialysis after a one year follow up, in comparison to the group with repeated biopsies (90% vs. 10%, P = .002). Eighty percent of the patients with a repeated biopsy had a modification in their immunosuppressive treatment as a result of the serial biopsy. In this group, 57.9% of the patients received a more aggressive immunosuppressive treatment or a new treatment strategy.

Conclusions

Repeated renal biopsies in lupus nephritis allow an early modification of the immunosuppressive strategy, prevent progressive decline in renal function, and limit the use of dialysis in this group of patients.