Strategy for second kidney biopsy in patients with lupus nephritis
Strategy for second kidney biopsy in patients with lupus nephritis
复制标题
DOI：
10.1093/ndt/gfr517
复制
发表时间：
2012-04-01
影响因子：
6.1
通讯作者：
Kfoury, Hala
中科院分区：
文献类型：
--
作者：
Alsuwaida, Abdulkareem;Husain, Sufia;Kfoury, Hala
背景资料。标准的临床和实验室参数在区分活动性狼疮性肾炎和慢性疾病方面的预测价值有限。这项研究的目的是检验第二次肾活检对狼疮性肾炎患者的预测价值。狼疮性肾炎患者被建议在他们的治疗维持阶段结束时进行第二次肾活检。对临床数据视而不见的病理学家对基线和第二次肾活检进行重新分类。研究缓解状态与组织学参数之间的关系。这项研究包括77名患者，平均随访时间为8.7年(四分位数范围为5.3-10.1年)。完全缓解者(CR)、部分缓解者(PR)和未缓解者(NR)的肾脏存活率分别为93%、69%和41%。在第二次活检中，三分之一的PR患者和14%的NR患者没有活动性疾病的组织学证据。在第二次活组织检查，而不是在基线活组织检查时，活动性指数预测存活。无论缓解状态如何，活动性指数为0的患者10年肾存活率为100%，二次活检者活动性指数为1或2的患者为80%，活动性指数为2的患者为44%。第二，在维持治疗阶段结束时，肾活检是一种重要的诊断和预后工具，可以指导医生采取更安全的做法，获得更好的结果。
Background. 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.Methods. 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.Results. 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.Conclusion. 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.