Repeat Kidney Biopsies May Ameliorate Lupus Nephritis Flares

AUTHOR:
James Matera, DO
Practicing Nephrologist, Senior Vice President for Medical Affairs, and Chief Medical Officer
CentraState Medical Center
Freehold, New Jersey

Compared with conventional management, biopsy-informed management of maintenance immunosuppression improves the flare rate among patients with lupus nephritis, according to a recent study.

In this study, 76 patients with lupus nephritis received a maintenance biopsy after the first biopsy. Immunosuppression was continued if histologic activity was present and discontinued if it was absent.

If those for whom the therapy was discontinued ended up experiencing a flare, induction immunosuppression was restarted. The process of histologic evaluation and continuation or discontinuation of immunosuppression continued until no patients showed histologic activity.

After the first repeat biopsy, 21 patients showed histologic activity and continued therapy, and 55 had stopped therapy when no activity was found. Six of those patients had experienced a flare.

After the second repeat biopsy, 6 patients continued therapy and 20 had stopped therapy, which was followed by one flare among those patients.

No patients undergoing a third repeat biopsy had histologic activity.

This translates into the need to treat 10 patients under the biopsy-managed protocol to prevent one flare.

Repeat biopsy is clearly useful for helping to manage patients, but the biopsies should be performed at centers with experience in performing them, due to potential risks.

Reference:

Malvar A, Alberton V, Lococo B, et al. Kidney biopsy-based management of maintenance immunosuppression is safe and may ameliorate flare rate in lupus nephritis. Kidney Int. 2020;97(1):156-162. https://doi.org/10.1016/j.kint.2019.07.018