The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese
The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese
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DOI：
10.1111/j.1523-1755.2004.66027.x
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发表时间：
2004-12-01
影响因子：
19.6
通讯作者：
Furuichi, K
中科院分区：
文献类型：
--
作者：
Yokoyama, H;Wada, T;Furuichi, K
背景。狼疮性肾小球肾炎 (LGN) 的预后存在很大差异。因此，最近国际肾脏病学会/肾脏病理学会 (ISN/RPS) 2003 年分类在判断人类 LGN 长期结果方面的临床实用性已得到研究。方法。我们回顾性研究了 60 名 LGN 受试者（7 名男性，53 名女性，平均年龄 33 岁），他们接受了肾活检，并随访 1 至 366 个月，平均 187 个月。根据新的WHO1995年LGN分类，将肾脏病理诊断为三级、活动性病变和硬化性病变，并分析影响LGN预后的临床病理因素。新分类在类别判断方面获得了更高的共识（98% vs. 83%，P = 0.0084）。初始活检时IV-S级（N = 6）或IV-G级（N = 17）组的终末期肾衰竭（ESRF）发生率高于I、II、III或V级组（40.9% vs. 2.6%，P < 0.001）。 IV 级的平均 50% 肾存活时间为 189 +/- 29 个月，IV-S 级患者的预后往往较差（IV-S 为 95 +/- 22 个月，IV-G 为 214 +/- 35 个月，P = 0.1495）。通过逐步模型，IV 类也被选为 ESRF 最显着的危险因素（P = 0.002）。在 IV 级（-S 或 -G）ESRF 的子分析中，仅选择包括甲基泼尼松龙冲击疗法在内的治疗作为主要结局的显着改善因素（P = 0.034）。此外，活动指数是初次肾活检后死亡和/或 ESRF 的重要危险因素（P = 0.043）。对于精算患者在所有随访期间的死亡，抗磷脂综合征或肾病综合征并发症是显着的危险因素（分别为P = 0.013，P = 0.041）。结论。新的 ISN/RPS 2003 分类提供了与长期肾脏结局相关的有益病理信息以及预防 LGN 患者 ESRF 和/或死亡的最佳治疗方法。
Background. A considerable diversity in prognosis is seen with lupus glomerulonephritis (LGN). Hence, the clinical usefulness of a recent International Society of Nephrology/ Renal Pathology Society (ISN/ RPS) 2003 classification to judge the long- term outcome of human LGN has been investigated.Methods. We studied retrospectively 60 subjects with LGN (7 males, 53 females, mean age of 33 years old) who underwent renal biopsies and were followed from 1 to 366 months, with a mean of 187 months. We diagnosed renal pathology as classes, active and sclerosing lesions, according to the new and WHO1995 classification of LGN, and analyzed the clinicopathologic factors affecting to the prognosis of LGN.Results. New classification got much higher consensus in the judgment of classes (98% vs. 83%, P = 0.0084). The group of Class IV- S (N = 6) or IV- G (N = 17) at initial biopsies showed higher rate of end- stage renal failure (ESRF) compared with that of Class I, II, III or V (40.9% vs. 2.6%, P < 0.001). The mean 50% renal survival time of Class IV was 189 +/- 29 months, and patients with Class IV- S tended to have a poorer prognosis (95 +/- 22 months for IV- S vs. 214 +/- 35 months for IV- G, P = 0.1495). Class IV was also selected as the most significant risk factor for ESRF by stepwise model (P = 0.002). In sub-analysis for ESRF in Class IV (- S or -G), treatment including methylprednisolone pulse therapy was only selected as a significant improving factor for primary outcome (P = 0.034). In addition, activity index was the significant risk factor of death and/ or ESRF after initial renal biopsies (P = 0.043). As for actuarial patient death during all follow- up periods, complications with anti-phospholipid syndrome or nephrotic syndrome were significant risk factors (P = 0.013, P = 0.041, respectively).Conclusion. New ISN/ RPS 2003 classification provided beneficial pathologic information relevant to the long- term renal outcome and the optimal therapy preventing ESRF and/ or death in patients with LGN.