The value of repeated biopsy in lupus nephritis management

Renal biopsy is essential in the initial evaluation of patients with lupus nephritis (LN). However, the role of repeated renal biopsy during the follow-up is controversial. Repeated biopsy during follow-up of patients with LN may represent a useful tool in difficult cases to evaluate the histological response to therapy, to modulate the intensity of treatment, and to predict the long-term renal outcome. Persistent or progressive proteinuria, worsening of renal function, no remission and renal flare are established indications for repeat a renal biopsy, with the main objective of guiding immunosuppressive treatment. There is growing evidence that repeated biopsies after induction or maintenance treatment can better evaluate prognosis compared to first biopsy and can detect histological activity in patients without clinical and laboratorial signs of active LN. However, there is no clear consensus on whether a biopsy should be repeated after induction or maintenance treatment.