The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese.
BACKGROUND
A considerable diversity in prognosis is seen with lupus glomerulonephritis (LGN). Hence, the clinical usefulness of a recent International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification to judge the long-term outcome of human LGN has been investigated.


METHODS
We studied retrospectively 60 subjects with LGN (7 males, 53 females, mean age of 33 years old) who underwent renal biopsies and were followed from 1 to 366 months, with a mean of 187 months. We diagnosed renal pathology as classes, active and sclerosing lesions, according to the new and WHO1995 classification of LGN, and analyzed the clinicopathologic factors affecting to the prognosis of LGN.


RESULTS
New classification got much higher consensus in the judgment of classes (98% vs. 83%, P = 0.0084). The group of Class IV-S (N = 6) or IV-G (N = 17) at initial biopsies showed higher rate of end-stage renal failure (ESRF) compared with that of Class I, II, III or V (40.9% vs. 2.6%, P < 0.001). The mean 50% renal survival time of Class IV was 189 +/- 29 months, and patients with Class IV-S tended to have a poorer prognosis (95 +/- 22 months for IV-S vs. 214 +/- 35 months for IV-G, P = 0.1495). Class IV was also selected as the most significant risk factor for ESRF by stepwise model (P = 0.002). In subanalysis for ESRF in Class IV (-S or -G), treatment including methylprednisolone pulse therapy was only selected as a significant improving factor for primary outcome (P = 0.034). In addition, activity index was the significant risk factor of death and/or ESRF after initial renal biopsies (P = 0.043). As for actuarial patient death during all follow-up periods, complications with anti-phospholipid syndrome or nephrotic syndrome were significant risk factors (P = 0.013, P = 0.041, respectively).


CONCLUSIONS
New ISN/RPS 2003 classification provided beneficial pathologic information relevant to the long-term renal outcome and the optimal therapy preventing ESRF and/or death in patients with LGN.
Yokoyama
Hitoshi
H
Division of Blood Purification, Kanazawa University Hospital, Department of Gastroenterology and Nephrology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. dialysis@medf.m.kanazawa-u.ac.jp
Wada
Takashi
T
Hara
Akinori
A
Yamahana
Junya
J
Nakaya
Izaya
I
Kobayashi
Motoo
M
Kitagawa
Kiyoki
K
Kokubo
Satoshi
S
Iwata
Yasunori
Y
Yoshimoto
Keiichi
K
Shimizu
Kazuaki
K
Sakai
Norihiko
N
Furuichi
Kengo
K
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000628:therapy; D007678:Kidney Glomerulus / Q000473:pathology; D008181:Lupus Nephritis / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome