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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Main Authors: Vasudevan Chelliah, V Balaraman, S Ilango, S Ramesh, V Kannan Bhaba, D Shivakumar
Format: Article
Language:English
Published: SAGE Publishing 2017-01-01
Series:Indian Journal of Rheumatology
Subjects:
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.
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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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