SAN DIEGO—As part of a Nov. 14 session on lupus nephritis at ACR Convergence 2023, Simone Appenzeller, MD, PhD, shared perspectives on the importance of biopsy to inform its diagnosis, prognosis and treatment, with an emphasis on childhood disease.
Prompt diagnosis and treatment of lupus nephritis is perhaps even more important for children than for adults because of the risk of kidney failure and longer total lifetime impact. Kidney involvement in systemic lupus erythematosus is less common in adults than children, said Dr. Appenzeller, professor in the Department of Orthopedics, Rheumatology and Traumatology at the State University of Campinas, São Paulo, Brazil. She noted that kidney involvement is present in more than half of children with the disease. When lupus nephritis occurs in children, usually within the first two years of disease onset, it’s often more severe than in adults.1
Opinions on the optimal use of kidney biopsy in both adult and pediatric lupus have been evolving. Exactly when or how often the test should ideally be employed is unclear, and practitioners continue to weigh the diagnostic benefits of the gold standard test against the risks of an invasive procedure.2 Part of the diagnostic challenge is that established, non-invasive diagnostic markers often give incomplete information. For example, traditional laboratory markers, such as anti-double-stranded DNA antibody and complement, are often poor at detecting an early lupus nephritis flare; they also possess limited sensitivity and specificity in distinguishing active disease from earlier damage. Newer blood or urine markers and marker panels may eventually provide more informative results, but these are still likely to prove supplemental to biopsy.3
Dr. Appenzeller
