When a kidney biopsy is mandatory in SLE
When does a kidney biopsy need to be performed in the setting of SLE?
Any patient suspected of having lupus nephritis should be further evaluated with a kidney biopsy.
This procedure is considered when abnormalities—such as protein, blood, or casts—are present on urinalysis, often coupled with abnormal serology or reduced kidney function.
Severe involvement, such as nephrotic syndrome or nephritic syndrome with or without kidney failure, will require a kidney biopsy for further evaluation.
Even when subtle abnormalities are present clinically (i.e., normal kidney function with or without hematuria and less than 1 g of proteinuria/day), severe lupus nephritis may be present on kidney biopsy.
Thus a kidney biopsy should be performed to establish a diagnosis, determine prognosis, and guide therapy. Many patients may require more than one biopsy during their disease course.
This procedure may be necessary to alter therapy, because the characteristics of lupus nephritis may change over time or to determine if there is late progression of the disease, which may not be amenable to further immunosuppressive treatment.
