Repeat renal biopsy findings in 82 lupus nephritis patients: a clinicopathological study

Lupus nephritis (LN) is among the most severe complications of systemic lupus erythematosus and is associated with increased mortality. The aim of this study was to explore the value and clinical utility of repeat renal biopsies in patients with LN.

We conducted a retrospective study of patients with biopsy-proven LN who had undergone at least two renal biopsies at First Affiliated Hospital of Guangxi Medical University from June 1, 2012 to March 31, 2024. A comparative analysis was conducted on the clinical data obtained from both renal biopsies, including demographic information, clinical manifestations, laboratory results, and pathological findings collected at the time of each biopsy. Paired sample T-test and chi-square test were used for statistical analysis.

A total of 82 patients met the inclusion criteria. The male-to-female ratio of our study cohort was 1:5.83. At the first biopsy, the predominant pathological types were class IV (23.2%) and class III+V (24.4%) lupus nephritis (LN). In contrast, at the repeat biopsy, class IV (25.6%) and class IV+V (24.4%) were the most common types. Among the 82 patients included in the study, 51 (62.2%) exhibited worsening pathological types, while 24 (29.3%) showed no improvement. Compared with results obtained at the first biopsy, the prevalence of crescents increased significantly from 19.5% to 45.1%, the prevalence rates of proteinuria, pyuria, and cellular casts, as well as pathological findings of global sclerosis, tubular atrophy, interstitial fibrosis, and inflammatory cell infiltration were increased at the second biopsy (P<0.05). Estimated glomerular filtration rates were lower at the second than those at the first biopsy (P<0.05).

Renal biopsy should be repeated in patients with LN who have undergone treatment if urinalysis results and renal function worsen or do not improve to determine whether the pathological class of LN has changed and whether LN is in the active phase. Repeat renal biopsies show increased chronicity, the pathological types are predominantly non-remitting or worsening, with a considerable proportion of patients also presenting with crescentic glomerulonephritis. Repeat renal biopsy is necessary for the diagnosis of LN patients and may inform the design of subsequent treatment plans.