DIFFUSE PROLIFERATIVE LUPUS NEPHRITIS - IDENTIFICATION OF SPECIFIC PATHOLOGIC FEATURES AFFECTING RENAL OUTCOME
DIFFUSE PROLIFERATIVE LUPUS NEPHRITIS - IDENTIFICATION OF SPECIFIC PATHOLOGIC FEATURES AFFECTING RENAL OUTCOME
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DOI：
10.1038/ki.1984.75
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发表时间：
1984-01-01
影响因子：
19.6
通讯作者：
BALOW, JE
中科院分区：
文献类型：
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作者：
AUSTIN, HA;MUENZ, LR;BALOW, JE
弥漫增生性狼疮性肾炎：影响肾脏预后的特异性病理特征的鉴定对102例狼疮性肾炎前瞻性治疗试验患者随机分组前的肾活检标本进行了检查，试图确定肾功能衰竭结局的早期预测因子。所有11例肾功能衰竭均发生在72例弥漫性增生性或膜增生性肾小球肾炎（DPGN/MPGN）患者中;因此，与局灶性增生性、膜性或系膜性肾小球肾炎患者相比，这些患者的终末期肾病风险中度但显著增加。考虑到DPGN/MPGN患者中终末期肾脏疾病的发生率较低，我们试图通过个体组织学特征的半定量评分和活动性（Al）和慢性（CI）指数指定的复合组织学评分的推导来细化从肾脏形态学获得的预后信息。在72例DPGN/MPGN患者中，复合AL比单个活动性组织学特征更能预测肾功能衰竭;细胞新月体和广泛纤维素样坏死产生正相关，而毛细血管内增生、白细胞渗出和肾小球透明血栓以及间质炎症本身并不能作为有用的诊断指标。然而，慢性项目（肾小球硬化、纤维性新月体、肾小管萎缩和间质纤维化）单独考虑以及复合CI中，对肾衰竭结局具有高度预测性。特别引人注目的是肾小管萎缩的预后价值;所有11例肾功能衰竭均发生在43例随机化前肾活检显示肾小管萎缩的患者中。虽然没有一个单一的病理变量改善肾小管萎缩的预后预测，检查变量之间的相互作用显示，肾小球硬化和细胞新月体有协同作用，增加了来自单独分析肾小管萎缩的预后信息。因此，肾小管萎缩、肾小球硬化和细胞新月体的同时发生确定了一个非常高风险的组; 9名患者中有6名在进入研究的4年内进展为终末期肾病。总之，个体组织学特征的半定量评分可以改善对DPGN或MPGN狼疮患者肾功能衰竭风险的估计。弥漫性狼疮增生：影响肾脏演变的特殊病理学特征的鉴定。随机化前对102例患者的肾脏活检标本进行检查，以确定是否存在肾脏功能不全的原因。共有11例肾功能不全，其中72例表现为弥漫性增生性或膜性增生性肾小球肾炎（DPGN/MPGN）;此外，这些疾病存在一种危险的模式，但迈斯意义重大，根据报告的一组表现为局灶性、膜外或系膜增生性肾小球肾炎。考虑到DPGN/MPGN患者中终末期肾病的发生率较低，我们将从肾脏形态学部分中获取相关的信息，
Diffuse proliferative lupus nephritis: Identification of specific patholog-ic features affecting renal outcome. Prerandomization renal biopsy specimens were examined in 102 patients upon entry into prospective therapeutic trials of lupus nephntis in an attempt to identify early predictors of renal failure outcome. All 11 renal failures occurred among the 72 individuals with diffuse proliferative or membranoproliferative glomerulonephritis (DPGN/MPGN); thus, these patients were at modestly, but significantly, increased risk of endstage renal disease compared to those with focal proliferative, membranous, or mesangial glomerulonephritis. Considering the low incidence of endstage renal disease among patients with DPGN/MPGN, we sought to refine the prognostic information obtained from renal morphology by semiquanti-tative scoring of individual histologic features and by derivation of composite histologic scores specified by Activity (Al) and Chronicity (CI) Indices. Among the 72 patients with DPGN/MPGN, the composite AL was more strongly predictive of renal failure than were the individual active histologic features; cellular crescents and extensive fibrinoid necrosis yielded positive associations, while endocapillary prolifera-tion, leucocytic exudation, and hyaline thrombi in glomeruli and interstitial inflammation by themselves did not emerge as useful prog-nostic indicators. However, chronicity items (glomerular sclerosis, fibrous crescents, tubular atrophy, and interstitial fibrosis) considered individually, as well as in the composite CI, were highly predictive of renal failure outcome. Particularly striking was the prognostic value of tubular atrophy; all 11 renal failures were among the 43 patients with tubular atrophy on prerandomization renal biopsy. While no single pathologic variable improved outcome predictions among those with tubular atrophy, examination for interactions among variables revealed that glomerular sclerosis and cellular crescents had a synergistic effect which augmented the prognostic information derived from analysis of tubular atrophy alone. Thus, the simultaneous occurrence of tubular atrophy, glomerular sclerosis, and cellular crescents identified a very high-risk group; six of nine patients progressed to endstage renal disease within 4 years of study entry. In conclusion, semiquantitative scoring of individual histologic features can refine estimates of the risk of renal failure in lupus patients with DPGN or MPGN.Néphrite lupique proliferative diffuse: Identification de caracteristiques pathologiques spécifiques affectant l'évolution rénale. Les specimens biopsies rénales de 102 malades avant randomisation ont été examinées a l'entrée dans des essais therapeutiques prospectifs de Ia néphrite lupique, destinés a identifier les facteurs prédictifs precoces de survenue d'une insuffisance rénale. La totalité des 11 insuffisances rénales est survenue parmi les 72 sujets atteints d'une glomérulonephrite diffuse proliferative ou membrano-proliferative (DPGN/MPGN); ainsi, ces malades avaient un risque modérément, mais significativement, accru de nephropathie terminale, par rapport a ceux atteints d'une glomérulonéphnte proliferative focale, extramembraneuse ou mesangiale. En considérant Ia faible incidence d'une néphropathie terminale parmi les patients atteints de DPGN/MPGN, nous avons cherchC a affiner l'information pronostique obtenue a partir de Ia morphologie rénale par un