What is the role of renal biopsy in the workup of lupus nephritis?

Updated: Mar 04, 2019
  • Author: Lawrence H Brent, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Renal biopsy may be useful in patients with recurrent episodes of nephritis, depending on the clinical circumstances. By revealing the histologic pattern and stage of disease (activity and chronicity), renal biopsy is useful in determining prognosis and treatment. Findings from a thorough clinical and laboratory evaluation can be used to predict the histologic type of lupus nephritis in approximately 70-80% of patients; however, this is not accurate enough, in view of the toxicity of some of the treatment protocols.

A good rule is to perform a renal biopsy if the findings will potentially alter patient management. If a particular patient has other manifestations of SLE (eg, severe central nervous system [CNS] or hematologic involvement) and will be treated with cyclophosphamide, biopsy may not be necessary but should still be considered because it may help predict renal outcome.

Sampling error can occur during a renal biopsy. Thus, the results of the biopsy should always be evaluated for consistency with the clinical and laboratory presentation of the patient.

The experience of pathologists in reading lupus nephritis biopsy specimens varies considerably. Studies have suggested that the most consistent readers are in larger medical centers with substantial populations of patients with SLE.


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