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DOI: 10.1055/a-1489-6248
Stellenwert der Nierenbiopsie bei Lupusnephritis
Diagnostic value of renal biopsy in lupus nephritis![](https://www.thieme-connect.de/media/10.1055-s-00034922/202105/lookinside/thumbnails/10-1055-a-1489-6248-1.jpg)
ZUSAMMENFASSUNG
Bei systemischem Lupus erythematodes (SLE) findet sich häufig eine renale Mitbeteiligung, der verschiedene pathogenetische Mechanismen zugrunde liegen. Die Nierenbeteiligung hat einen negativen Einfluss auf die Prognose des SLE, insbesondere bei progredienter Niereninsuffizienz. Eine Nierenbiopsie ist aufgrund der Heterogenität der Nierenbeteiligung und der damit verbundenen therapeutischen Konsequenzen unabdingbar. Sie kann durch nicht-invasive Untersuchungen wie die Urindiagnostik oder Serologie nicht ersetzt werden, da das Ausmaß der Proteinurie oder der Mikrohämaturie keine sicheren Rückschlüsse auf den Schweregrad, die Pathogenese und die Prognose der Nierenbeteiligung erlauben. Die Nierenbiopsie gibt neben der korrekten Klassifikation der Lupusnephritis (LN) Informationen über die Mitbeteiligung des Niereninterstitium, der intrarenalen Gefäße und der Aktivität sowie Chronizität der Nephritis. Auch kann der Pathologe die Frage beantworten, inwieweit mit einer Besserung der Nierenfunktion unter Therapie gerechnet werden kann. Der folgende Beitrag gibt einen Überblick über den Stellenwert der Nierenbiopsie bei SLE, der revidierten Klassifikation der LN von 2018 einschließlich Sonderformen der LN und über die Implikationen des Biopsie-Ergebnisses für die Therapie.
SUMMARY
Systemic lupus erythematosus (SLE) is often associated with renal involvement with various underlying pathogenic mechanisms. Lupus nephritis (LN) has a major influence on the prognosis and mortality of SLE patients. Diagnostic kidney biopsy is essential for differentiating the various types of LN and for choosing the corresponding treatment options. Non-invasive urine and serum markers are not specific and do not allow for inferences to be made on LN classes, pathogenesis and prognosis of kidney involvement. In addition, a kidney biopsy provides important information about tubulointerstitial disease, vascular involvement as well as activity and chronicity of LN. We review the diagnostic role of renal biopsy in SLE, the revised LN classification, other renal manifestations in SLE and implications of biopsy findings on treatment.
Keywords
Systemic lupus erythematosus - lupus nephritis - renal biopsy - classification - kidney biopsyPublikationsverlauf
Artikel online veröffentlicht:
11. Oktober 2021
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Literatur
- 1 Anders H-J, Weening JJ. Kidney disease in lupus is not always ‘lupus nephritis’. Arthritis research & Therapy 2013; 15: 108-109
- 2 Aringer M, Costenbader K, Daikh D. et al 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 1151-1159
- 3 Huerta A, Bomback AS, Liakopoulos V. et al Renal-limited ‘lupus-like’ nephritis. Nephrol Dial Transplant 2012; 27: 2337-2342
- 4 Weening JJ, D’Agati VD, Schwartz MM. et al International Society of Nephrology Working Group on the Classification of Lupus Nephritis; Renal Pathology Society Working Group on the Classification of Lupus Nephritis. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004; 65: 521-530
- 5 Bajema IM, Wilhelmus S, Alpers CE. et al Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int 2018; 93: 789-796
- 6 Yang J, Liang D, Zhang H. et al Long-term renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis. Lupus 2015; 24: 1468-1478
- 7 Seshan SV, Jennette JC. Renal disease in systemic lupus erythematosus with emphasis on classification of lupus glomerulonephritis: advances and implications. Arch Pathol Lab Med 2009; 133: 233-248
- 8 Wang SF, Chen YH, Chen DQ. et al Mesangial proliferative lupus nephritis with podocytopathy: a special entity of lupus nephritis. Lupus 2018; 27: 303-311
- 9 Chen D, Hu W. Lupus podocytopathy: a distinct entity of lupus nephritis. J Nephrol 2018; 31: 629-634
- 10 Londoño Jimenez A, Mowrey WB, Putterman C. et al Brief Report: Tubulointerstitial Damage in Lupus Nephritis: A Comparison of the Factors Associated With Tubulointerstitial Inflammation and Renal Scarring. Arthritis Rheumatol 2018; 70: 1801-1806
- 11 Clark MR, Trotter K, Chang A. The Pathogenesis and Therapeutic Implications of Tubulointerstitial Inflammation in Human Lupus Nephritis. Semin Nephrol 2015; 35: 455-464
- 12 Wang H, Xu J, Zhang X. et al Tubular basement membrane immune complex deposition is associated with activity and progression of lupus nephritis: a large multicenter Chinese study. Lupus 2018; 27: 545-555
- 13 Yung S, Chan TM. Molecular and Immunological Basis of Tubulo-Interstitial Injury in Lupus Nephritis: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 52: 149-163
- 14 Kaul A, Agrawal V, Bhaduaria D. et al Vasculitis and vasculopathy in Lupus Nephritis: Clinical variability, outcome,and new insight into treatment. Saudi J Kidney Dis Transpl 2017; 28: 415-424
- 15 Appel GB, Pirani CL, D’Agati V. Renal vascular complications of systemic lupus erythematosus. J Am Soc Nephrol 1994; 04: 1499-1515
- 16 Song D, Wu LH, Wang FM. et al The spectrum of renal thrombotic microangiopathy in lupus nephritis. Arthritis Res Ther 2013; 15: R12
- 17 Park MH, Caselman N, Ulmer S. et al Complement-mediated thrombotic microangiopathy associated with lupus nephritis. Blood Adv 2018; 02: 2090-2094
- 18 Jarrot PA, Chiche L, Hervier B. et al Systemic Lupus Erythematosus and Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Overlap Syndrome in Patients With Biopsy-Proven Glomerulonephritis. Medicine (Baltimore) 2016; 95: e3748
- 19 Turner-Stokes T, Wilson HR, Morreale M. et al Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy. Kidney Int 2017; 92: 1223-1231
- 20 Bienaimé F, Legendre C, Terzi F. et al Antiphospholipid syndrome and kidney disease. Kidney Int 2017; 91: 34-44
- 21 Alchi B, Griffiths M, Jayne D. What nephrologists need to know about antiphospholipid syndrome. Nephrol Dial Transplant 2010; 25: 3147-3154
- 22 Restrepo-Escobar M, Granda-Carvajal PA, Jaimes F. Systematic review of the literature on reproducibility of the interpretation of renal biopsy in lupus nephritis. Lupus 2017; 26: 1502-1512
- 23 Sethi S, Haas M, Markowitz GS. et al Mayo Clinic/Renal Pathology Society Consensus Report on Pathologic Classification, Diagnosis, and Reporting of GN. J Am Soc Nephrol 2016; 27: 1278-1287
- 24 Sethi S, Fervenza FC. Standardized classification and reporting of glomerulonephritis. Nephrol Dial Transplant 2019; 34: 193-199
- 25 Kudose S, Santoriello D, Bomback AS. et al Sensitivity and Specificity of Pathologic Findings to Diagnose Lupus Nephritis. Clin J Am Soc Nephrol 2019; 14: 1605-1615
- 26 Chen S, Tang Z, Zhang Y. et al Significance of Histological Crescent Formation in Patients with Diffuse Proliferative Lupus Nephritis. Am J Nephrol 2013; 38: 445-452
- 27 Obrişcă B, Jurubiă R, Andronesi A. et al Histological predictors of renal outcome in lupus nephritis: the importance of tubulointerstitial lesions and scoring of glomerular lesions. Lupus 2018; 27: 1455-1463
- 28 Fanouriakis A, Kostopoulou M, Alunno A. et al 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 736-745
- 29 Wilson PC, Kashgarian M, Moeckel G. Interstitial inflammation and interstitial fibrosis and tubular atrophy predict renal survival in lupus nephritis. Clin Kidney J 2018; 11: 207-218
- 30 Abdellatif AA, Waris S, Lakhani A. et al True vasculitis in lupus nephritis. Clin Nephrol 2010; 74: 106-112
- 31 Tang Y, Qin W, Peng W. et al Development and validation of a prediction score system in lupus nephritis. Medicine (Baltimore) 2017; 96: e8024
- 32 Martínez-Martínez MU, Llamazares-Azuara LM, Martínez-Galla D. et al Urinary sediment suggests lupus nephritis histology. Lupus 2017; 26: 580-587
- 33 Mavragani CP, Fragoulis GE, Somarakis G. et al Clinical and laboratory predictors of distinct histopathogical features of lupus nephritis. Medicine (Baltimore) 2015; 94: e829
- 34 Tang Y, Zhang W, Zhu M. et al Lupus nephritis pathology prediction with clinical indices. Sci Rep 2018; 08: 10231
- 35 Christopher-Stine L, Siedner M, Lin J. et al Renal biopsy in lupus patients with low levels of proteinuria. J Rheumatol 2007; 34: 332-335
- 36 Wakasugi D, Gono T, Kawaguchi Y. et al Frequency of class III and IV nephritis in systemic lupus erythematosus without clinical renal involvement: an analysis of predictive measures. J Rheumatol 2012; 39: 79-85
- 37 Kwon OC, Park Y, Lee JS. et al Non-albumin proteinuria as a parameter of tubulointerstitial inflammation in lupus nephritis. Clin Rheumatol 2019; 38: 235-241
- 38 Singh A, Ghosh R, Kaur P. et al Protocol renal biopsy in patients with lupus nephritis: a single center experience. Saudi J Kidney Dis Transpl 2014; 25: 801-807
- 39 Narváez J, Ricse M, Gomà M. et al The value of repeat biopsy in lupus nephritis flares. Medicine (Baltimore) 2017; 96: e7099
- 40 Pakozdi A, Pyne D, Sheaff M. et al Utility of a repeat renal biopsy in lupus nephritis: a single centre experience. Nephrol Dial Transplant 2018; 33: 507-551
- 41 Kajawo S, Botha FCJ, Okpechi IG. Clinico-pathological features of repeat renal biopsies in patients with lupus nephritis at Groote Schuur Hospital, Cape Town. Lupus 2017; 26: 1339-1346
- 42 Tannor EK, Bates WD, Moosa MR. The clinical relevance of repeat renal biopsies in the management of lupus nephritis: a South African experience. Lupus 2018; 27: 525-535
- 43 Tøndel C, Vikse BE, Bostad L. et al Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988–2010. Clin J Am Soc Nephrol 2012; 07: 1591-1597
- 44 Steffel J, Verhamme P, Potpara TS. et al The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39: 1330-1393
- 45 Onuigbo MAC, Sharma V, Balogun OO. et al Post-Renal Biopsy Acute Kidney Injury and Page Kidney from Intra-Renal Hematoma Aggravated by Reversible Contrast-Induced Nephropathy Following Renal Arterial Embolization. Am J Case Rep 2020; 21: e919701