Tubulointerstitial lesions of patients with lupus nephritis classified by the 2003 International Society of Nephrology and Renal Pathology Society system.
The 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) system for classifying patients with lupus nephritis was based on glomerular lesions exclusively, despite the fact that lupus nephritis affects all compartments of the kidney. Hence, we analyzed the tubulointerstitial lesions in patients with lupus nephritis within the different classes and subclasses of the 2003 ISN/RPS system. Among 313 patients from five centers in northern China with lupus nephritis, interstitial inflammatory cell infiltration, tubular atrophy, and interstitial fibrosis were severe in 170 patients with class IV, moderate in 55 with class III, and mild in 19 with class II and in 69 with class V disease, each with significance. The severity of tubulointerstitial lesions in classes IV-segmental and III was similar, whereas the score of interstitial inflammatory cell infiltration in patients with subclass IV-global was significantly higher than that in those with subclass IV-segmental. Interstitial fibrosis and tubular atrophy were each significantly more prominent in patients with both active and chronic lesions than in those with active lesions alone. The correlation coefficient ranged from 0.222 to 0.811 comparing glomerular and tubulointerstitial indices. In multivariate Cox hazard analysis of tubulointerstitial lesions, indices of interstitial infiltration, tubular atrophy, and interstitial fibrosis were confirmed as significant independent risk factors for renal outcome. Thus, we found that the 2003 ISN/RPS classification system of lupus nephritis, based on glomerular lesions, could also reflect related tubulointerstitial lesions. Hence, we suggest that the extent of tubulointerstitial lesions may be helpful in predicting renal outcome in patients with lupus nephritis.
Yu
Feng
F
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Wu
Li-Hua
LH
Tan
Ying
Y
Li
Li-Hua
LH
Wang
Cai-Li
CL
Wang
Wen-Ke
WK
Qu
Zhen
Z
Chen
Meng-Hua
MH
Gao
Jun-Jie
JJ
Li
Zeng-Yan
ZY
Zheng
Xin
X
Ao
Jie
J
Zhu
Sai-Nan
SN
Wang
Su-Xia
SX
Zhao
Ming-Hui
MH
Zou
Wan-Zhong
WZ
Liu
Gang
G
D002681:China; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007678:Kidney Glomerulus / Q000473:pathology*; D008181:Lupus Nephritis / Q000145:classification* / Q000473:pathology*; D015999:Multivariate Analysis; D009398:Nephrology / Q000145:classification; D012307:Risk Factors; D012952:Societies