Lupus Nephritis Outcome With and Without Renal Biopsy

BACKGROUND: : Renal biopsy is an important tool in devising an adequate treatment plan for lupus nephritis. However, it is not always possible to perform a biopsy, and in many cases, treatment must rely exclusively on clinical data. OBJECTIVE: : The aim of this study was to compare the 5-year course of patients treated without a biopsy with another group with histologic evidence of diffuse proliferative glomerulonephritis (DPGN). METHODS: : The no-biopsy group consisted of 30 patients with lupus with strong clinical and laboratory suspicion of proliferative glomerulonephritis in whom a renal biopsy was unavailable either because of medical contraindication or the patient's refusal. The biopsy group included 30 patients undergoing biopsy and a histologic diagnosis of DPGN. Patients were followed from the onset of nephritis and at 18, 36, and 60 months. RESULTS: : At onset, the no-biopsy group showed lower C3 levels and higher proteinuria, although both groups showed evident deterioration of the renal function. No significant differences were found in treatment, outcome, survival, renal function tests, or in the development of kidney failure. CONCLUSIONS: : Proliferative glomerulonephritis deserves prompt diagnosis and treatment. This study demonstrates that experience in the management of lupus nephropathy, together with clinical and laboratory data, are often enough information to adequately treat proliferative glomerulonephritis even in the absence of a renal biopsy.