Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis?
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...
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| Format: | Article |
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SAGE Publishing
2017-01-01
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| Series: | Indian Journal of Rheumatology |
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| Online Access: | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2017;volume=12;issue=1;spage=12;epage=16;aulast=Chelliah |
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| author | Vasudevan Chelliah V Balaraman S Ilango S Ramesh V Kannan Bhaba D Shivakumar |
| author_facet | Vasudevan Chelliah V Balaraman S Ilango S Ramesh V Kannan Bhaba D Shivakumar |
| author_sort | Vasudevan Chelliah |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-51b4da2e1a5740548e265915c48c3e34 |
| institution | Kabale University |
| issn | 0973-3698 0973-3701 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Indian Journal of Rheumatology |
| spelling | doaj-art-51b4da2e1a5740548e265915c48c3e342025-02-03T11:52:04ZengSAGE PublishingIndian Journal of Rheumatology0973-36980973-37012017-01-01121121610.4103/0973-3698.199121Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis?Vasudevan ChelliahV BalaramanS IlangoS RameshV Kannan BhabaD ShivakumarObjective: 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.http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2017;volume=12;issue=1;spage=12;epage=16;aulast=ChelliahAnti-dsDNAcomplementlupus nephritisrenal biopsy |
| spellingShingle | Vasudevan Chelliah V Balaraman S Ilango S Ramesh V Kannan Bhaba D Shivakumar Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis? Indian Journal of Rheumatology Anti-dsDNA complement lupus nephritis renal biopsy |
| title | Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis? |
| title_full | Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis? |
| title_fullStr | Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis? |
| title_full_unstemmed | Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis? |
| title_short | Is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis? |
| title_sort | is renal biopsy always necessary to start immunosuppressive therapy in lupus nephritis |
| topic | Anti-dsDNA complement lupus nephritis renal biopsy |
| url | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2017;volume=12;issue=1;spage=12;epage=16;aulast=Chelliah |
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