Tubulointerstitial lesions in lupus nephritis: International multicentre study in a large cohort of patients with repeat biopsy
Tubulointerstitial lesions in lupus nephritis: International multicentre study in a large cohort of patients with repeat biopsy
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DOI：
10.1111/nep.12555
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发表时间：
2016-01-01
期刊：
影响因子：
2.5
通讯作者：
Ferrario, Franco
中科院分区：
文献类型：
--
作者：
Pagni, Fabio;Galimberti, Stefania;Ferrario, Franco
背景资料：肾小球中心国际肾脏病学会/肾脏病理学会（ISN/RPS）分类是评价狼疮性肾炎的金标准，而肾小管间质（TIN）参数在病理报告中往往被低估。方法：对142例接受重复活检（RB）的患者的肾活检进行以下组织学参数的评价：（i）炎性间质浸润;（ii）间质纤维化;（iii）肾小管炎;和（iv）肾小管萎缩。四个TIN变量之间的相互关系进行了多变量分析。一个线性混合模型被用来调查潜在的影响，TIN变量对eGFR和蛋白尿在两个活检occasion.Results：研究表明，中重度病变并不那么频繁的参考活检，但更广泛的代表后RB。两种炎症指标之间以及与慢性损伤相关的指标之间存在很强的相关性，而与ISN/RPS分类的关系在RB中存在。如果IV-G级与TIN相关性最大（尤其是在RB时），则也证实了II级患者中存在原发性TIN。最后，我们的研究结果支持这一假设，即肾小管炎是一个独立的预测因子eGFR.Conclusions：我们建议，标准的SLE肾炎的组织学评价还包括TIN功能。
Background: The glomerulocentric International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification is the gold standard for the evaluation of lupus nephritis, while tubulointerstitial (TIN) parameters are often under-recognized in pathological reports.Methods: Renal biopsies from 142 patients who underwent repeat biopsy (RB) were evaluated for the following histological parameters: (i) inflammatory interstitial infiltrates; (ii) interstitial fibrosis; (iii) tubulitis; and (iv) tubular atrophy. The inter-relationships between the four TIN variables were explored by multivariate analysis. A linear mixed model was used to investigate the potential impact of TIN variables on eGFR and proteinuria at the two biopsy occasions.Results: The study showed that moderate-severe lesions were not so frequent at the reference biopsy, but more extensively represented upon RB. A strong association was found between the two inflammatory indices and between those related to chronic damage, while the relationship with the ISN/RPS classification was present at RB. If class IV-G was the most related with TIN (especially at RB), the existence of primary TIN in class II patients was also confirmed. Finally, our results support the hypothesis that tubulitis is an independent predictive factor for eGFR.Conclusions: We recommend that the standard histological evaluation of SLE nephritis also includes TIN features.