Faisal Naseeb, Khalid Parvez, Muhammad Afzal Hamdani, Abdul Rehman Alarfaj, Hala Kfoury, Joseph Hope Cal.
Change seen in histological pattern in patients with lupus nephritis with positive antiphospholipid serology.
Pak J Med Res Jan ;57(3):105-9.
Background: It is debatable whether a repeat renal biopsy during lupus nephritis (LN) flare is helpful in guiding the treatment and predicting prognosis. Objective: To determine the value of serial renal biopsies in detecting histological changes in patients with lupus nephritis with APL antibodies. Study design, settings and Duration: This cross sectional retrospective study was conducted at King Saud University Medical City Riyadh, Kingdom of Saudi Arabia (KSA) during May 2013 to August 2017. Patients and Methods: Patients having diagnosis of systemic lupus erythematosus (SLE) with positive APL antibodies and who underwent two or more renal biopsies for various indications were included into the study. The histological features of serial renal biopsies were compared. Renal biopsies were reassessed with light microscopy, immunofluorescence and electron microscopic studies and were categorized according to ISN/RPS 2004 classification. Data was analyzed using chi-square test to assess the differences between categorical study variables. Results: A total of 15 patients with LN having positive APL antibodies were included. The mean age of the patients was 38±10.5 years, and the disease duration was 160±9 months. The Interval between the two biopsies was 73.5±48 months. Antiphospholipid syndrome nephropathy (APSN) was noted in 4 (26%) patients at time of the first renal biopsy and in 9 (60%) on repeat biopsies. Thrombotic microangiopathy (TMA) which is the hallmark of APSN was detected in the repeat biopsy in two patients Change in the histological class was frequent and was seen in 12 out of the 15 patients while patients with proliferative LN class switching to non-proliferative class was rare. Conclusion: Histological changes are common in serial biopsies in patients with lupus nephritis with positive APL serology. Repeat renal biopsies led to change in immunosuppression treatment in more than half of patients on average. Key words: Renal biopsy, antiphospholipid syndrome nephropathy, lupus nephritis, thrombotic microangiopathy, systemic lupus erythematosus.
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