New subcategories of class IV lupus nephritis: Are there clinical, histologic, and outcome differences?
New subcategories of class IV lupus nephritis: Are there clinical, histologic, and outcome differences?
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DOI：
10.1053/j.ajkd.2004.08.027
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发表时间：
2004-12-01
影响因子：
13.2
通讯作者：
Singh, AK
中科院分区：
文献类型：
--
作者：
Mittal, B;Hurwitz, S;Singh, AK
背景：国际肾脏病学会和肾脏病理学会 (ISN/RPS) 狼疮性肾炎分类提出了有争议的 IV 级狼疮性肾炎亚分类，分为 IV 段性 (IV-S) 和 IV-整体性 (IV-G)。方法：使用 ISN/RPS 分类对经活检证实的狼疮性肾炎患者队列进行回顾性分析。结果：70 名狼疮性肾炎患者的 IV 级患病率为 47%。在 33 名 IV 级狼疮性肾炎患者中，11 名患者为 IV-S 级，22 名患者为 IV-G 级。两组的年龄、性别和种族没有显着差异。 IV-S 组观察到较高的血清学活性（较低的 C4 水平），而 IV-G 组的血清肌酐水平和舒张压显着较高。两组的血细胞比容水平、显着蛋白尿（尿蛋白大于或等于3(+)）、系统性红斑狼疮持续时间和系统性红斑狼疮疾病活动指数相似。组织学上，IV-S 组中伴有节段性毛细血管内增殖和纤维蛋白样坏死的复合病变明显更常见。 IV-S 组中具有细胞新月体的肾小球百分比也较高，但差异并不显着。线环在 IV-G 组中更为常见。在 IV-S 组重复活检的 3 个样本中，有 2 个观察到向 IV-G 的转变；超过 50% 的 IV-G 组有节段性和整体性肾小球受累。 IV-S 组和 IV-G 组分别平均随访 38 个月和 55 个月后，两组结果未发现显着差异。结论：IV-S 和 IV-G 之间的临床和预后区别仍有待证实。
Background: The International Society of Nephrologists and Renal Pathology Society (ISN/RPS) classification of lupus nephritis proposes a controversial subclassification of class IV lupus nephritis into IV-segmental (IV-S) and IV-global (IV-G). Methods: A retrospective analysis of a biopsy-proven cohort of patients with lupus nephritis using the ISN/RPS classification was performed. Results: The prevalence of class IV was 47% in the cohort of 70 patients with lupus nephritis. Of 33 patients with class IV lupus nephritis, 11 patients had class IV-S and 22 patients had class IV-G. There were no significant differences in age, sex, and ethnicity in the 2 groups. Greater serological activity (lower C4 level) was observed in the IV-S group, whereas serum creatinine levels and diastolic blood pressures were significantly greater in the IV-G group. Hematocrit levels, significant proteinuria (urine protein greater than or equal to3(+)), duration of systemic lupus erythematosus, and the Systemic Lupus Erythematosus Disease Activity Index were similar in the 2 groups. Histologically, combined lesions with segmental endocapillary proliferation and fibrinoid necrosis were significantly more frequent in the IV-S group. The percentage of glomeruli with cellular crescents also was greater in the IV-S group, but the difference was not significant. Wire loops were more common in the IV-G group. Transformation to IV-G was observed in 2 of 3 specimens from repeated biopsies available in the IV-S group; greater than 50% of the IV-G group had both segmental and global glomerular involvement. No significant difference was detected in outcomes in the 2 groups after average follow-ups of 38 and 55 months in the IV-S and IV-G groups, respectively. Conclusion: A clinical and prognostic distinction between IV-S and IV-G remains to be proven.