Algorithm for using the kidney biopsy to manage maintenance therapy of lupus nephritis. After the initial diagnostic biopsy, a repeated biopsy can be considered upon finishing induction therapy in patients who have completely responded. Some of these patients may be able to avoid prolonged treatment with immunosuppression, but this is not currently recommended. Most patients will be given maintenance immunosuppression after induction. Patients who achieve a complete renal response and have received more than 3 years of therapy are candidates for withdrawal of immunosuppression. This decision may be facilitated by a repeated biopsy to confirm histologic remission. Patients who do not achieve a complete clinical response, but have responded partially, may be considered for a repeat biopsy to determine whether they have attained a histologic remission. If so, and after a similar duration of total immunosuppressive therapy, such patients may be considered for withdrawal of maintenance therapy.
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Figure 1 Algorithm for using the kidney biopsy to manage maintenance therapy of lupus nephritis. After the initial diagnostic biopsy, a repeated biopsy can be considered upon finishing induction therapy in patients who have completely responded. Some of these patients may be able to avoid prolonged treatment with immunosuppression, but this is not currently recommended. Most patients will be given maintenance immunosuppression after induction. Patients who achieve a complete renal response and have received more than 3 years of therapy are candidates for withdrawal of immunosuppression. This decision may be facilitated by a repeated biopsy to confirm histologic remission. Patients who do not achieve a complete clinical response, but have responded partially, may be considered for a repeat biopsy to determine whether they have attained a histologic remission. If so, and after a similar duration of total immunosuppressive therapy, such patients may be considered for withdrawal of maintenance therapy.
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Lupus Nephritis: The Case for Repeat Kidney Biopsy in the Management of Maintenance Therapy
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