ROLE OF RENAL BIOPSY IN SILENT LUPUS NEPHRITIS M.E. Guerra 1 , Y. Arce 2 , M.M Díaz 3 , P. Moya 4 . J. Ballarín 3 , F. Algaba 5 1 Department of Pathology. Central University Hospital of Asturias, Oviedo. Spain 2 Department of Pathology. Puigvert Foundation, Barcelona. Spain. 3 Department of Nephrology. Puigvert Foundation, Barcelona. Spain 4 Department of Rheumatology. Sant Pau Hospital, Barcelona. Spain. 5 Department of Pathology. Puigvert Foundation, Barcelona. Spain.
ROLE OF RENAL BIOPSY IN SILENT LUPUS NEPHRITIS. M.E. Guerra 1 , Y. Arce 2 , M.M Díaz 3 , P. Moya 4 . J. Ballarín 3 , F. Algaba 5 1 Department of Pathology . Central University Hospital of Asturias, Oviedo. Spain 2 Department of Pathology . Puigvert Foundation , Barcelona. Spain . - PowerPoint PPT Presentation
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
ROLE OF RENAL BIOPSY IN SILENT LUPUS NEPHRITIS
M.E. Guerra1 , Y. Arce2, M.M Díaz3, P. Moya4. J. Ballarín3, F. Algaba5
1Department of Pathology. Central University Hospital of Asturias, Oviedo. Spain2Department of Pathology. Puigvert Foundation, Barcelona. Spain.
3Department of Nephrology. Puigvert Foundation, Barcelona. Spain4Department of Rheumatology. Sant Pau Hospital, Barcelona. Spain.
5Department of Pathology. Puigvert Foundation, Barcelona. Spain.
• Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease primarily affecting women of reproductive age.
• Kidney disease develops up to 60% of patients with SLE:• 15-20% first clinical manifestation.• 25-50% had renal involvement at the time of lupus diagnosis.• Important cause of morbility, even mortality.
• Goals for managing patients with lupus nephritis (LN):• Early diagnosis• Proper and prompt therapy to prevent irreversible damage without
exposure of side effects of immunosupressors.
INTRODUCTION
• Renal Biopsy is essential to diagnose specific form of LN:
• Biological markers (serum levels C3, C4, anti-DNA): low sensitivity to predict activity disease and risk to develop new flares.
• Discrepancies between clinical presentation and pathologic findings.
• LN is not a static entity.
• Implies different prognosis and therapeutic approaches.
• Repeat biopsy in LN flares is a matter of controversy.
• Its role is still not defined after clinical remission.
• Daleboudt Gabrielle M. N. et al. Nephrol Dial Transplant (2009)• Hsieh YP. Clin Nephrol 2012; 77: 18-24..• Seshan S. Arch Pathol Lab Med. 2009;133:233–48.
INTRODUCTION
SILENT LUPUS NEPHRITIS (SLN)
• Zabaleta-Lanz M et al. Lupus 2003;12:26-30.• Zabaleta-Lanz M et al. Inmunol 2004; 23: 278-83.• Zabaleta-Lanz M et al. Lupus 2006; 15: 845-51.
• Moroni G. Am J Kidney Diseases.1999; 34:530–9.• Yoo CW. Nephrol Dial Transplant. 2000;15:1604–8. • Cavallo T. Am J Pathol1977;87:1–13• Ahmadian YS, Am J Dis Child 1972;123: 121 – 125.
OBJECTIVES
• Evaluate frequency of SLN in patients with at least one previous renal flare with histological confirmation, after induction/maintenance treatment, that achieved complete renal and clinical remission.
• Correlate complete renal remission with histological findings and compare them to those obseved in previous biopsy.
• Examine the influence of histological change in the therapeuthic decision.
• Prospective and descriptive study.
• Review of patients diagnosed of SLE , as defined by American Rheumatism Association, that had LN biopsy-proven.
• Selection of patients who fulfill complete remission (CR) criteria for at least 2 years. 2nd biopsy is performed at this moment