Markowitz G S, D'Agati V D
Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Kidney Int. 2007 Mar;71(6):491-5. doi: 10.1038/sj.ki.5002118. Epub 2007 Jan 31.
The 2003 International Society of Nephrology (ISN)/Renal Pathology Society (RPS) Classification of lupus nephritis (LN) was designed to eliminate ambiguities and standardize definitions. Major changes from the 1982 Modified WHO Classification include the elimination of the normal biopsy category and the subcategories of membranous Class V, the introduction of sharper distinctions between the classes, and the addition of subcategories within diffuse LN (class IV) for predominantly segmental (LN IV-S) and global (LN IV-G) lesions. It stipulates that sclerotic glomeruli owing to scarred LN should be taken into account when assessing the percentage of glomeruli affected by LN. Since its publication, the ISN/RPS classification has been used successfully in a number of clinical-pathologic studies. Several studies addressing the relationship between LN IV-S and LN IV-G have failed to identify a significantly worse outcome in IV-S than IV-G, although there were some differences in presenting clinical and pathologic features. Importantly, the ISN/RPS classification has achieved its goal of improved interobserver reproducibility. Its use has increased the percentage of LN biopsies meeting criteria for class IV. As it gains widespread acceptance, the ISN/RPS classification is already providing a standardized approach to renal biopsy interpretation needed to compare outcome data across centers.
2003年国际肾脏病学会（ISN）/肾脏病理学会（RPS）狼疮性肾炎（LN）分类旨在消除歧义并规范定义。与1982年修订的世界卫生组织分类相比，主要变化包括取消正常活检类别和V类膜性狼疮性肾炎的亚类，在各类型之间引入更明确的区分，以及在弥漫性LN（IV类）中增加主要为节段性（LN IV-S）和全球性（LN IV-G）病变的亚类。它规定，在评估受LN影响的肾小球百分比时，应考虑因LN瘢痕形成导致的硬化性肾小球。自发布以来，ISN/RPS分类已成功应用于多项临床病理研究。几项针对LN IV-S和LN IV-G之间关系的研究未能确定IV-S的预后明显比IV-G差，尽管在临床表现和病理特征上存在一些差异。重要的是，ISN/RPS分类实现了提高观察者间可重复性的目标。其应用增加了符合IV类标准的LN活检比例。随着它得到广泛认可，ISN/RPS分类已经为跨中心比较结局数据提供了一种标准化的肾活检解读方法。
