Hunter Michael G, Hurwitz Shelley, Bellamy Christopher O C, Duffield Jeremy S
MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom.
Kidney Int. 2005 Jan;67(1):94-102. doi: 10.1111/j.1523-1755.2005.00059.x.
Lupus nephritis encompasses a wide range of parenchymal injuries and severity. Better predictors of outcome are needed for patients newly diagnosed with lupus nephritis, so that an appropriate management strategy may be selected.
A single-center cohort of first renal biopsies for lupus nephritis was chosen. Histologic sections of whole biopsy cores were stained with picro-Sirius red, and light microscopic images (x100) were digitally captured. Using a simple, freely available software package, the cortex of each biopsy was evaluated for four different parameters: area occupied by nuclei, intratubular space, fibrillary collagen, and collagenous matrix. Clinical and laboratory data were collected retrospectively from the time of biopsy and throughout follow-up.
A high nuclear index at initial biopsy correlated with clinical parameters of disease activity, at the time of biopsy. High collagen matrix index predicted both relapse and progression to end-stage renal disease (ESRD). The fibrillary collagen index predicted progressive disease as assessed by doubling of serum creatinine, and relapse. Increased tubular space also predicted progressive disease as determined by doubling of creatinine and renal death.
A simple automated system for objectively scoring biopsies of lupus nephritis predicts renal survival and may provide a useful adjunct to guide patient management.
狼疮性肾炎包含广泛的实质损伤和严重程度。新诊断的狼疮性肾炎患者需要更好的预后预测指标，以便选择合适的管理策略。
选取狼疮性肾炎首次肾活检的单中心队列。整个活检组织块的组织学切片用苦味酸天狼星红染色，并对光镜图像（×100）进行数字采集。使用一个简单的免费软件包，对每个活检组织的皮质评估四个不同参数：细胞核所占面积、肾小管内空间、纤维状胶原和胶原基质。从活检时及整个随访过程中回顾性收集临床和实验室数据。
初次活检时高核指数与活检时疾病活动的临床参数相关。高胶原基质指数可预测复发和进展至终末期肾病（ESRD）。纤维状胶原指数可预测血清肌酐翻倍评估的疾病进展和复发。肾小管空间增加也可预测肌酐翻倍和肾死亡所确定的疾病进展。
一种用于客观评分狼疮性肾炎活检组织的简单自动化系统可预测肾脏存活率，并可能为指导患者管理提供有用的辅助手段。
