Abstract | OBJECTIVES: To determine if the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification of lupus nephritis (LN) is helpful in predicting renal outcome. METHODS: A total of 92 patients with LN who underwent renal biopsy in our hospital were re-classified according to the ISN/RPS 2003 criteria. RESULTS: The mean patient age was 36.8 yrs and the median observation period was 65 months. The relative frequency for each class was as follows: Class I (minimal mesangial LN) 0%, Class II (mesangial proliferative LN) 13%, Class III (focal LN) 17%, Class IV (diffuse LN) 60% and Class V (membranous LN) 10%. Within Class IV, diffuse segmental (Class IV-S) was 25% and diffuse global (Class IV-G) 75%. During the observation period, renal function was more likely to deteriorate in Class IV-G cases than in Class IV-S cases. Importantly, when Class IV-G was subdivided into cases involving active lesion alone [IV-G (A)] or chronic lesion [IV-G (A/C)], the majority of cases in IV-G (A) was nephrotic, but responded well to therapy. In contrast, renal function declined only in IV-G (A/C) cases. Patients with Class IV-G (A/C) had persistent proteinuria in spite of intensified therapies. Moreover, the higher proportion of chronic lesions was related with the deterioration of renal function. CONCLUSIONS: This study showed that in Class IV-G cases, renal outcome differed in the presence of chronicity. Chronicity could be a critical factor in predicting outcome. Thus, the revised classification of LN is clinically valuable in identifying different renal outcomes among patients with diffuse LN.
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Authors | N Hiramatsu, T Kuroiwa, H Ikeuchi, A Maeshima, Y Kaneko, K Hiromura, K Ueki, Y Nojima |
Journal | Rheumatology (Oxford, England)
(Rheumatology (Oxford))
Vol. 47
Issue 5
Pg. 702-7
(May 2008)
ISSN: 1462-0332 [Electronic] England |
PMID | 18390590
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Biomarkers
(blood)
- Chronic Disease
- Creatinine
(blood)
- Female
- Humans
- Kidney Failure, Chronic
(pathology)
- Kidney Glomerulus
(pathology, physiopathology)
- Lupus Nephritis
(classification, pathology, physiopathology)
- Male
- Middle Aged
- Prognosis
- Proteinuria
- Statistics, Nonparametric
- Treatment Outcome
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