title: Inclusion of renal vascular lesions in the 2003 ISN/RPS system for classifying lupus nephritis improves renal outcome predictions.
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.
authors.affiliation: Renal Division, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Peking-Tsinghua Center for Life Sciences, Beijing, People's Republic of China.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Wu
authors.forename: Feng
authors.initials: F
authors.lastname: Yu
authors.forename: Ying
authors.initials: Y
authors.lastname: Tan
authors.forename: Zhen
authors.initials: Z
authors.lastname: Qu
authors.forename: Meng-Hua
authors.initials: MH
authors.lastname: Chen
authors.forename: Su-Xia
authors.initials: SX
authors.lastname: Wang
authors.forename: Gang
authors.initials: G
authors.lastname: Liu
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000936:Antigen-Antibody Complex / Q000032:analysis; D050197:Atherosclerosis / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D001808:Blood Vessels / Q000276:immunology / Q000473:pathology; D002681:China; D002908:Chronic Disease; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000098:blood supply*; D008181:Lupus Nephritis / Q000145:classification / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D057049:Thrombotic Microangiopathies / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D014657:Vasculitis / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D055815:Young Adult
chemical_list: D000936:Antigen-Antibody Complex; D015415:Biomarkers