title: The renal histopathology in systemic vasculitis: an international survey study of inter- and intra-observer agreement.
abstract: In order to relate histopathological findings of the kidney in systemic vasculitis to renal outcome, scoring of various morphological parameters is necessary. Therefore, we conducted a standardization study for evaluating renal biopsies from patients with systemic vasculitis. Four experienced renal pathologists from four European centres joined in the study. A scoring protocol was devised that required the observers to score an extensive number of histopathological lesions either quantitatively (as a percentage of the total number of glomeruli) or dichotomously (on a present/absent scale). Twenty renal biopsies were scored individually by all the observers, from which the inter-observer variability was analysed. Ten randomly chosen biopsies were scored again, in order to obtain the intra-observer variability. For inter-observer agreement, the evaluation of the quantitative variables was satisfactory for both rounds (0.55 < or = Kendall's W < or = 0.95 and 0.59 < or = W < or = 0.96, respectively, with all P < 0.05). However, the inter-observer agreement for the dichotomous data was poor (kappa < or = 0.30 in more than half of the parameters in both rounds). Also the data on intra-observer agreement showed more favourable results for the analysis of the quantitative data (Pearson's r > 0.45 in more than 85% of the variables in both rounds) than for the dichotomous scoring system (kappa < or = 0.30 in more than half of the variables). It is concluded that even between experienced renal pathologists discrepancies occur in scoring kidney biopsies. Inter- and intra-observer agreement is greater if a quantitative method for reviewing the biopsies is applied that requires the observers to score the tissue specimens systematically.
authors.affiliation: Department of Pathology, Leiden University, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Bajema
authors.forename: E C
authors.initials: EC
authors.lastname: Hagen
authors.forename: B E
authors.initials: BE
authors.lastname: Hansen
authors.forename: J
authors.initials: J
authors.lastname: Hermans
authors.forename: L H
authors.initials: LH
authors.lastname: Noël
authors.forename: R
authors.initials: R
authors.lastname: Waldherr
authors.forename: F
authors.initials: F
authors.lastname: Ferrario
authors.forename: F J
authors.initials: FJ
authors.lastname: van der Woude
authors.forename: J A
authors.initials: JA
authors.lastname: Bruijn
mesh_terms: D001706:Biopsy; D003625:Data Collection; D005060:Europe; D006801:Humans; D007668:Kidney / Q000473:pathology*; D009398:Nephrology / Q000592:standards* / Q000706:statistics & numerical data; D015588:Observer Variation; D014657:Vasculitis / Q000473:pathology*