The prognosis and pathogenesis of severe lupus glomerulonephritis
The prognosis and pathogenesis of severe lupus glomerulonephritis
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DOI：
10.1093/ndt/gfm775
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发表时间：
2008-04-01
影响因子：
6.1
通讯作者：
Lewis, Edmund J.
中科院分区：
文献类型：
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作者：
Schwartz, Melvin M.;Korbet, Stephen M.;Lewis, Edmund J.
背景。国际肾脏病学会/肾脏病理学会对狼疮性肾小球肾炎 (GN) 的分类 (ISN/RPS) 将弥漫性 GN（>= 50% 受累）分为弥漫性节段性肾炎 (IV-S) 和弥漫性全局性肾小球肾炎 (IV-G)。该划分测试发病机制和临床结果是否与使用世界卫生组织 (WHO) 分类将相似患者分为严重节段性 (WHO III >= 50%) 和弥漫性整体 (WHO-IV) GN 时相同。方法。使用 ISN/RPS 对 39 个 WHO IV 级肾活检和 44 个 WHO III >= 50% 的肾活检进行重新分类，并与发病机制和结果相关。结果。有 22 个活检组织的 ISN/RPS IV-S 级。 ISN/RPS IV-G 级包括两个形态上离散的肾活检类别：39 个活检最初被分类为 WHO IV 级 (WHO-IV)，22 个活检从 WHO III >= 50% 转换为 ISN/RPS IV-G (IV-Q)。我们将分别分析IV-S、IV-Q和WHO-IV。 WHO-IV 的免疫聚集物沉积明显多于 IV-S 和 IV-Q。 WHO-IV 患者的血清补体 C3（P=0.05）和 C4（P=0.05）低于 IV-Q 患者。 WHO-IV 患者的缓解率 (56%) 高于 IV-Q (23%) (P = 0.01)，并且 IV-Q (18%) 患者末次随访时肾功能稳定的频率低于 IV-S (50%，P = 0.05) 和 WHO-IV (62%，P = 0.001)。当患者被诊断为WHO III级= 50%和IV级时，肾存活率和无终末期肾病的肾存活率不同，但ISN/RPS IV-S级和IV-G级（WHO-IV加IV-Q）的结果没有差异。结论。 WHO III = 50% 和 WHO-IV 狼疮 GN 与 ISN/RPS IV-S 和 IV-G 不一致。 ISN/RPS 最大限度地减少了 IV-S 类和 IV-G 类之间的病理和结果差异，从而导致肾活检信息内容的丢失。 ISN/RPS 无法检测严重狼疮 GN 患者之间的发病或临床差异。
Background. The International Society of Nephrology/ Renal Pathology Society classification (ISN/RPS) of lupus glomerulonephritis (GN) divides diffuse GN (>= 50% involvement) into diffuse segmental (IV-S) and diffuse global GN (IV-G). This division tests whether the pathogenesis and clinical outcomes are the same as when similar patients are classified using the World Health Organization ( WHO) classification into severe segmental ( WHO III >= 50%) and diffuse global (WHO-IV) GN.Methods. Thirty-nine renal biopsies with WHO class IV and 44 with WHO III >= 50% were reclassified using the ISN/RPS and were correlated with pathogenesis and outcome.Results. There were 22 biopsies with ISN/RPS class IV-S. ISN/RPS class IV-G comprises two morphologically discrete classes of renal biopsies: 39 biopsies originally classified as WHO class IV (WHO-IV) and 22 that switched from WHO III >= 50% to ISN/RPS class IV-G (IV-Q). We will analyze IV-S, IV-Q and WHO-IV separately. WHO-IV had significantly more immune aggregate deposition than IV-S and IV-Q. WHO-IV had lower serum complements C3 ( P= 0.05) and C4 ( P = 0.05) than patients with IV-Q. Patients with WHO-IV had more remissions (56%) than IV-Q ( 23%) ( P= 0.01), and stable renal function at the last follow-up was less frequent in patients with IV-Q (18%) than IV-S ( 50%, P = 0.05) and WHO-IV (62%, P= 0.001). Renal survival and renal survival without end-stage renal disease were different when the patients were diagnosed as WHO classes III = 50% and IV, but the outcomes for ISN/RPS class IV-S and IV-G (WHO-IV plus IV-Q) were not different.Conclusions. WHO III = 50% and WHO-IV lupus GN are not congruent with ISN/RPS IV-S and IV-G. The ISN/RPS minimizes pathological and outcome differences between classes IV-S and IV-G which results in the loss of informational content from the renal biopsies. ISN/RPS does not detect pathogenetic or clinical differences among patients with severe lupus GN.