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Inclusion of renal vascular lesions in the 2003 ISN/RPS system for classifying lupus nephritis improves renal outcome predictions.
- Source :
-
Kidney international [Kidney Int] 2013 Apr; Vol. 83 (4), pp. 715-23. Date of Electronic Publication: 2013 Jan 09. - Publication Year :
- 2013
-
Abstract
- The 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) pathological classification system of lupus nephritis specified the importance of vascular damage and indicated this should be included in the diagnostic summary. Few pathological studies of lupus nephritis, however, focus on the patterns of renal vascular involvement. Here we assessed renal vascular lesions in lupus nephritis based on the 2003 ISN/RPS classification system and evaluated their association with clinical and pathological data in a large cohort from a single center in China. Among 341 patients with lupus nephritis, 279 were diagnosed with single or multiple renal vascular lesions that included 253 with vascular immune complex deposits, 82 with atherosclerosis, 60 with thrombotic microangiopathy, 13 with noninflammatory necrotizing vasculopathy, and 2 with true renal vasculitis. Patients with thrombotic microangiopathy had the poorest renal outcome. In multivariate Cox hazard analysis after inclusion of renal vascular lesions, the new chronicity index score became a significantly better independent risk factor for renal outcome (hazard ratio 2.32). Thus, renal vascular lesions are common in lupus nephritis and closely correlate with clinical disease activity and renal outcome. Inclusion of a detailed description of renal vascular lesions in the ISN/RPS classification of lupus nephritis may strengthen its predictive value for renal outcome.
- Subjects :
- Adult
Antigen-Antibody Complex analysis
Atherosclerosis classification
Atherosclerosis pathology
Atherosclerosis therapy
Biomarkers analysis
Biopsy
Blood Vessels immunology
Blood Vessels pathology
China
Chronic Disease
Female
Humans
Kaplan-Meier Estimate
Lupus Nephritis classification
Lupus Nephritis immunology
Lupus Nephritis pathology
Lupus Nephritis therapy
Male
Multivariate Analysis
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Risk Assessment
Risk Factors
Thrombotic Microangiopathies classification
Thrombotic Microangiopathies pathology
Thrombotic Microangiopathies therapy
Vasculitis classification
Vasculitis pathology
Vasculitis therapy
Young Adult
Atherosclerosis diagnosis
Kidney blood supply
Lupus Nephritis diagnosis
Thrombotic Microangiopathies diagnosis
Vasculitis diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1523-1755
- Volume :
- 83
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Kidney international
- Publication Type :
- Academic Journal
- Accession number :
- 23302713
- Full Text :
- https://doi.org/10.1038/ki.2012.409