Introduction:
Renal biopsy is the gold standard in diagnosis of lupus nephritis and the choice and intensity of immunosuppression depends on lupus class, activity and chronicity indices on biopsy. However renal biopsy is an invasive procedure, and it may not be feasible in lupus patients with thrombocytopenia or coagulation abnormalities. Renal shear wave elastography (SWE) is a novel, non-invasive method to assess renal fibrosis and in turn chronicity of the disease and its use in this context is not well studied. We aimed to evaluate the correlation between renal shear wave elastography and chronicity index (CI) on biopsy and its relationship with response to treatment on short term follow up at 6 months.
Methods:
A prospective observational study with 44 patients of lupus nephritis. All patients underwent renal shear wave elastography at the time of biopsy and their response to treatment after 6 months of initiation of induction was assessed.
Results:
Among the 44 patients, mean age was 35.09±6.39 years.Renal SWE positively correlated with creatinine levels(r=0.542,p=0.009).There was a statistically significant positive correlation between SWE values and chronicity index(r=0.576,p=0.005).The diagnostic performance of SWE in assessing severe chronicity (CI>4) was estimated using Receiver operating characteristic (ROC) curve.The area under ROC was 0.758.The optimal cut off value of SWE to differentiate those with severe chronicity was 10.8 kPa ,yielding a sensitivity of 70% and specificity of 85%.Short term response to induction therapy at 6 months was significantly associated with lower renal SWE values(p=0.002).
Conclusions:
Renal shear wave elastography positively correlated with chronicity index and a value of >10.8kPa could predict severe chronicity with a sensitivity of 70% and specificity of 85%. Lower shear wave values showed significant association with good response to therapy.Hence renal shear wave elastography may provide a novel noninvasive method for assessing chronicity,thus helping in deciding the intensity of immunosuppression and may help gain preliminary insight into response to treatment, especially in those whom biopsy may not be feasible.Further studies are needed to establish whether follow up SWE taken later during the course of treatment may help distinguish between a lupus nephritis relapse and chronicity which would otherwise require a renal biopsy to do so.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.