Full Papers
Lupus nephritis outcomes when kidney biopsy is not feasible: findings from a tertiary centre inception cohort
F. Kharouf1, P. Mehta2, Q. Li3, D.D. Gladman4, Z. Touma5, L.P. Whittall Garcia6
- University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada; and Rheumatology Unit, Department of Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
- University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada. laura.whittallgarcia2@uhn.ca
CER19623
Full Papers
Free to view
(click on article PDF icon to read the article)
PMID: 42446701 [PubMed]
Received: 15/12/2025
Accepted : 28/04/2026
In Press: 07/07/2026
Abstract
OBJECTIVES:
Baseline kidney biopsy is the gold standard for diagnosing lupus nephritis (LN). However, in certain cases, biopsy may not be feasible due to medical, technical, or patient-related factors, leading to a clinical diagnosis of LN. This study compares outcomes between biopsy-confirmed and clinically diagnosed LN to inform clinical decision-making in scenarios where a kidney biopsy is not feasible.
METHODS:
This retrospective study included patients with SLE enrolled between 2000 and 2024 who developed incident LN in an inception cohort at a tertiary centre. Inclusion began in 2000 to reflect treatment changes following the introduction of mycophenolate mofetil. Outcomes included: (1) complete proteinuria recovery (CPR) at 6 months and one year, and (2) a sustained ≥30% eGFR decline, end-stage kidney disease (ESKD), or death (composite outcome). Time-to-event outcomes were assessed using Kaplan-Meier curves and Cox proportional hazards regression.
RESULTS:
Among 127 patients with incident LN, 84 (66.1%) had biopsy-confirmed and 43 (33.9%) clinically diagnosed LN. Clinically diagnosed patients were younger, with lower baseline proteinuria and disease activity. CPR at 6 months and one year, as well as the composite outcome, did not differ significantly between groups. Individual events, including ≥30% eGFR decline, ESKD, and death, were also not statistically different.
CONCLUSIONS:
Renal outcomes were not statistically different between biopsy-confirmed and clinically diagnosed LN when managed with standard treatment in a tertiary care setting. These findings offer reassurance in cases where biopsy is not feasible; however, biopsy remains the diagnostic gold standard and should be pursued whenever possible.
