What is your threshold to repeat a kidney biopsy in a patient with a history of lupus nephritis who is on maintenance therapy and develops subtle changes in urinary protein excretion or microscopic hematuria?

There have been a number of lupus biopsy and treatment questions here lately. The management of lupus nephritis is VERY difficult with innumerable permutations of past and present, biopsy nuances, symptoms, and treatment histories.

The answer to this question depends on more than "subtle changes in...

My best answer would be that it is very much case-dependent. In general, with subtle changes, I don't re-biopsy. Sometimes, all that needs to be done is a little tweaking of the maintenance therapy. In addition to the degree of proteinuria, hematuria, and serum creatinine changes, serum complements ...

As someone who has a patient in their mid-20s awaiting renal transplant (noncompliant) who has had MPA, IgA nephropathy AND lupus nephritis on separate biopsies over a span of 10 years, I think previously is very important, especially if labs are not fitting otherwise with active LN. I typically con...