Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis?
| Autor: | D. Shivakumar, S Ramesh, S. Ilango, V Kannan Bhaba, V. Balaraman, Vasudevan Chelliah |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Pathology lcsh:Diseases of the musculoskeletal system Anti-dsDNA 030232 urology & nephrology Lupus nephritis Gastroenterology Serology 03 medical and health sciences 0302 clinical medicine Rheumatology renal biopsy Internal medicine Biopsy medicine complement Prospective cohort study 030203 arthritis & rheumatology lupus nephritis Proteinuria medicine.diagnostic_test biology business.industry medicine.disease biology.protein Renal biopsy Antibody medicine.symptom lcsh:RC925-935 Low Complement business |
| Zdroj: | Indian Journal of Rheumatology, Vol 12, Iss 1, Pp 12-16 (2017) |
| ISSN: | 0973-3701 0973-3698 |
| Popis: | Objective: Most of the patients with proliferative lupus nephritis (LN) have high titer of anti-dsDNA antibody and low complement levels. In this study, we tried to predict proliferative LN with serological profile. Methods: This prospective study was conducted in fifty pateints with known systemic lupus erythematosus (SLE) with laboratory evidence of LN (proteinuria, microscopic hematuria, or increased serum creatinine). Serological profile (anti-dsDNA, C3, and C4) and renal biopsy were done in all patients. Results: Of 50 patients, 35 had Class IV (70%), 7 Class II (14%), 4 Class V (8%), and 4 had Class IV and V (8%) on renal biopsy. Totally, 39 (78%) patients had proliferative LN (Class IV and Class IV and V). The prevalence of anti-dsDNA, low C3, and low C4 was 97.1%, 68%, and 74% with LN and 97.4%, 84.6%, and 87.2% with proliferative LN (P < 0.001), respectively. About 72% (28 of 39 patients) with proliferative LN had the combination of anti-dsDNA positivity, low C3, and low C4 levels. However, whoever had the combination of anti-dsDNA positivity, low C3, and low C4 showed only proliferative LN on biopsy. Positive predictive value was 100% (P < 0.05). None of the patients with Class II or Class V (nonproliferative LN) had this combination of serology. Conclusion: In this study, it was found that proliferative LN can be predicted by serological profile alone. Thus it might be argued that immunosuppressive therapy (steroids and mycophenolate mofetil) may be started without renal biopsy in a known SLE patient with laboratory evidence of LN and positive serology; however, robust studies are required. |
| Databáze: | OpenAIRE |
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