Stellenwert der Nierenbiopsie bei Lupusnephritis

Zusammenfassung

Bei systemischem Lupus erythematodes (SLE) findet sich häufig eine renale Mitbeteiligung, der verschiedene pathogenetische Mechanismen zugrunde liegen. Die Nierenbeteiligung hat einen negativen Einfluss auf die Prognose des SLE, insbesondere bei progredienter Niereninsuffizienz. Eine Nierenbiopsie ist aufgrund der Heterogenität der Nierenbeteiligung und der damit verbundenen therapeutischen Konsequenzen unabdingbar. Sie kann durch nicht-invasive Untersuchungen wie die Urindiagnostik oder Serologie nicht ersetzt werden, da das Ausmaß der Proteinurie oder der Mikrohämaturie keine sicheren Rückschlüsse auf den Schweregrad, die Pathogenese und die Prognose der Nierenbeteiligung erlauben. Die Nierenbiopsie gibt neben der korrekten Klassifikation der Lupusnephritis (LN) Informationen über die Mitbeteiligung des Niereninterstitium, der intrarenalen Gefäße und der Aktivität sowie Chronizität der Nephritis. Auch kann der Pathologe die Frage beantworten, inwieweit mit einer Besserung der Nierenfunktion unter Therapie gerechnet werden kann. Der folgende Beitrag gibt einen Überblick über den Stellenwert der Nierenbiopsie bei SLE, der revidierten Klassifikation der LN von 2018 einschließlich Sonderformen der LN und über die Implikationen des Biopsie-Ergebnisses für die Therapie.

Abstract

Systemic lupus erythematosus (SLE) is often associated with renal involvement with various underlying pathogenic mechanisms. Lupus nephritis (LN) has a major influence on the prognosis and mortality of SLE patients. Diagnostic kidney biopsy is essential for differentiating the various types of LN and for choosing the corresponding treatment options. Non-invasive urine and serum markers are not specific and do not allow for inferences to be made on LN classes, pathogenesis and prognosis of kidney involvement. In addition, a kidney biopsy provides important information about tubulointerstitial disease, vascular involvement as well as activity and chronicity of LN. We review the diagnostic role of renal biopsy in SLE, the revised LN classification, other renal manifestations in SLE and implications of biopsy findings on treatment.

Schlüsselwörter

Systemischer Lupus erythematodes - Lupusnephritis - Nierenbiopsie - Klassifikation

Key words

Systemic lupus erythematosus - lupus nephritis - renal biopsy - classification - kidney biopsy

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