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Arthritis und Rheuma 2021; 41(05): 348-357
DOI: 10.1055/a-1489-6248
Schwerpunkt

Stellenwert der Nierenbiopsie bei Lupusnephritis

Diagnostic value of renal biopsy in lupus nephritis
Stefan Markus Weiner∗
1   2. Medizinische Abteilung, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Johannes Gutenberg-Universität Mainz, Trier
2   KfH Nierenzentrum Nordallee, KfH Kuratorium für Dialyse und Nierentransplantation e. V., Trier
,
Rüdiger Waldherr∗
3   Pathologisches Institut, Ruprecht Karls Universität Heidelberg, Heidelberg
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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.

Schlüsselwörter

Systemischer Lupus erythematodes - Lupusnephritis - Nierenbiopsie - Klassifikation

Keywords

Systemic lupus erythematosus - lupus nephritis - renal biopsy - classification - kidney biopsy


Publication History

Article published online:
11 October 2021

© 2020. Thieme. All rights reserved.

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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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Huerta A, Bomback AS, Liakopoulos V. et al Renal-limited ‘lupus-like’ nephritis. Nephrol Dial Transplant 2012; 27: 2337-2342
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Chen D, Hu W. Lupus podocytopathy: a distinct entity of lupus nephritis. J Nephrol 2018; 31: 629-634
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 15 Appel GB, Pirani CL, D’Agati V. Renal vascular complications of systemic lupus erythematosus. J Am Soc Nephrol 1994; 04: 1499-1515
    CrossrefPubMedGoogle Scholar
  • 16 Song D, Wu LH, Wang FM. et al The spectrum of renal thrombotic microangiopathy in lupus nephritis. Arthritis Res Ther 2013; 15: R12
    CrossrefPubMedGoogle Scholar
  • 17 Park MH, Caselman N, Ulmer S. et al Complement-mediated thrombotic microangiopathy associated with lupus nephritis. Blood Adv 2018; 02: 2090-2094
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Bienaimé F, Legendre C, Terzi F. et al Antiphospholipid syndrome and kidney disease. Kidney Int 2017; 91: 34-44
    CrossrefPubMedGoogle Scholar
  • 21 Alchi B, Griffiths M, Jayne D. What nephrologists need to know about antiphospholipid syndrome. Nephrol Dial Transplant 2010; 25: 3147-3154
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 24 Sethi S, Fervenza FC. Standardized classification and reporting of glomerulonephritis. Nephrol Dial Transplant 2019; 34: 193-199
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 30 Abdellatif AA, Waris S, Lakhani A. et al True vasculitis in lupus nephritis. Clin Nephrol 2010; 74: 106-112
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 32 Martínez-Martínez MU, Llamazares-Azuara LM, Martínez-Galla D. et al Urinary sediment suggests lupus nephritis histology. Lupus 2017; 26: 580-587
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 34 Tang Y, Zhang W, Zhu M. et al Lupus nephritis pathology prediction with clinical indices. Sci Rep 2018; 08: 10231
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 39 Narváez J, Ricse M, Gomà M. et al The value of repeat biopsy in lupus nephritis flares. Medicine (Baltimore) 2017; 96: e7099
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar