Application of repeat renal biopsy in the diagnosis and treatment of immune-related glomerular diseases

Lupus nephritis, IgA nephropathy, nephrotic syndrome and other immune-related glomerular diseases have diverse etiologies, complex pathological changes and elusive pathogenetic mechanisms. Although many diagnostic and therapeutic strategies are readily available, precise managements are highly dependent upon renal biopsy pathology. Biopsy pathology provides information on glomerular and tubule-interstitial lesions, immune complex deposition and glomerular ultrastructural lesions. It helps to evaluate the severity of disease and guide a proper management. However, the prognosis of some patients has remained poor and the responses of clinical remission and histological remission to treatment are not always parallel. If patient symptoms are not alleviated, physician may perform a second renal biopsy to fine-adjust treatment and implement accurate management of disease. Thus repeat renal biopsy may provide the necessary information for diagnosing immune-related glomerular diseases, evaluating treatment outcomes, modifying treatment regimens and ultimately improving patient outcomes.