{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:50:04Z","timestamp":1791615004757,"version":"4.3.4"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus, and repeat kidney biopsy has a\u00a0potential value in monitoring disease progression and impact on treatment adjustments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 81 Egyptian LN patients who underwent two kidney biopsies at the Urology and Nephrology Center, Mansoura University, between January 2011 and April 2024. Indications included persistent proteinuria, active urinary sediment, or unexplained renal impairment. Demographic, clinical, laboratory, histological, and treatment data were collected. Pathology was assessed using the International Society of Nephrology\/Renal Pathology Society (ISN\/RPS) classification, activity and chronicity indices, and outcomes were analyzed by Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At repeat biopsy, pathological transitions occurred in 48%. The transition toward more severe disease categories was frequent and included: Class I\/II to III\/IV: 7 of 10 patients, Class III to IV: 6 of 11 patients, Class III\/IV + V to IV: all 3 patients, Class IV to VI: 5 of 49 patients, Class V to III\/IV\/VI: 6 of 8 patients. The activity index decreased (median 12\u21927, P &amp;lt; .001), while chronicity increased (2\u21924, P &amp;lt; .001). Treatment escalation was needed in 53.1% of patients. Over a median follow-up of 5.4 years, 56.8% progressed to kidney failure. Serum creatinine at both biopsies independently predicted kidney failure (Hazard ratio [HR] 1.24, P = .007; HR 1.22, P &amp;lt; .001). Shorter biopsy intervals were protective (HR 0.97, P &amp;lt; .001). At the second biopsy, chronicity index, glomerulosclerosis, and cellular crescents independently predicted kidney failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Repeat biopsy is of pivotal importance\u00a0in LN, unmasking critical histological transitions and shifts towards\u00a0chronicity that can\u00a0guide essential therapy changes and improve prognostication beyond clinical assessment alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajag097","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:44:34Z","timestamp":1775821474000},"page":"1222-1229","source":"Crossref","is-referenced-by-count":0,"title":["Repeat kidney biopsy unmasks the transition from active inflammation to irreversible damage in lupus nephritis: longitudinal outcomes from a single-center cohort in Egypt"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9849-1510","authenticated-orcid":false,"given":"Mohammed G","family":"Fetouh","sequence":"first","affiliation":[{"name":"Nephrology and Transplant Unit, Urology and Nephrology Center, Mansoura University , Gomhoria Street, Mansoura ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Sabry","sequence":"additional","affiliation":[{"name":"Nephrology Department, Faculty of Medicine, Mansoura University , Mansoura ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed A","family":"Fouda","sequence":"additional","affiliation":[{"name":"Nephrology and Transplant Unit, Urology and Nephrology Center, Mansoura University , Gomhoria Street, Mansoura ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Abdulrahim","sequence":"additional","affiliation":[{"name":"Pathology Unit, Urology and Nephrology Center, Mansoura University , Mansoura ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026101002221125700_aajag097-B1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.924766","article-title":"The role of organ-deposited IgG in the pathogenesis of multi-organ and tissue damage in systemic lupus erythematosus","volume":"13","author":"Qiu","year":"2022","journal-title":"Front Immunol."},{"key":"2026101002221125700_aajag097-B2","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1177\/09612033221106301","article-title":"Kidney thrombotic microangiopathy in lupus nephritis: impact on treatment and 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nephritis?","volume":"30","author":"Morales","year":"2021","journal-title":"Lupus"},{"key":"2026101002221125700_aajag097-B6","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1093\/ndt\/gfv296","article-title":"Histologic versus clinical remission in proliferative lupus nephritis","volume":"32","author":"Malvar","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"2026101002221125700_aajag097-B7","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2022-000689","article-title":"Clinical and histological findings at the second but not at the first kidney biopsy predict end-stage kidney disease in a large multicentric cohort of patients with active lupus nephritis","volume":"9","author":"Gatto","year":"2022","journal-title":"Lupus Sci Med."},{"key":"2026101002221125700_aajag097-B8","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2022-000721","article-title":"Predictors of increase in chronicity index and of kidney function impairment at repeat biopsy in lupus nephritis","volume":"9","author":"Moroni","year":"2022","journal-title":"Lupus Sci Med."},{"key":"2026101002221125700_aajag097-B9","doi-asserted-by":"publisher","first-page":"2","DOI":"10.5152\/eurjrheum.2019.18146","article-title":"Clinical impact of repeat renal biopsies in patients with lupus nephritis: renal biopsy is essential, especially later in the course of the disease","volume":"7","author":"Marinaki","year":"2019","journal-title":"Eur J Rheumatol."},{"key":"2026101002221125700_aajag097-B10","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/j.kint.2017.11.023","article-title":"Revision of the International Society of Nephrology\/Renal Pathology Society classification for lupus nephritis: clarification of definitions and modified National Institutes of Health activity and chronicity indices","volume":"93","author":"Bajema","year":"2018","journal-title":"Kidney Int."},{"key":"2026101002221125700_aajag097-B11","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2013-000004","article-title":"Value of repeat biopsy in lupus nephritis flares","volume":"1","author":"Greloni","year":"2014","journal-title":"Lupus Sci Med."},{"key":"2026101002221125700_aajag097-B12","doi-asserted-by":"publisher","first-page":"3014","DOI":"10.1093\/ndt\/gft272","article-title":"The value of repeat biopsy in the management of lupus nephritis: an international multicentre study in a large cohort of patients","volume":"28","author":"Pagni","year":"2013","journal-title":"Nephrol Dial Transplant"},{"key":"2026101002221125700_aajag097-B13","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1177\/0961203317726864","article-title":"The clinical relevance of repeat renal biopsies in the management of lupus nephritis: a South African 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