Athanazio Daniel Abensur, Sweet Gloria Maria Maranhão, Silva Carlos Alberto, dos-Santos Washington Luis Conrado
Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brasil.
Int Urol Nephrol. 2009;41(3):643-51. doi: 10.1007/s11255-008-9494-9. Epub 2008 Nov 7.
Chronic lesions in renal biopsies are a well recognized prognostic factor for renal diseases, including lupus nephritis. The methods used for assessment of chronic lesions are, however, largely based on semiquantitative evaluation and may lead to poor reproducibility. Interobserver variation is particularly important in lupus nephritis, in which acute and chronic lesions may occur simultaneously. In this study we tested the reproducibility of chronic lesion assessment performed by three pathologists, two with specific training in renal pathology, using 20 renal biopsies and a standard semiquantitative method. In a second experiment, we evaluated the reproducibility of chronic lesion assessment in 33 biopsies of lupus nephritis by the two nephropathologists. The semiquantitative estimated values were compared with those from a previously proposed morphometric method for quantification of chronic lesions in renal biopsies. Although correlations were observed among the estimated values, there was a wide range of variation when semiquantitative methods were used. In particular, activity and chronicity indices of lupus nephritis were poorly reproducible. In contrast, use of a morphometric score, although not eliminating interobserver variability, led to better reproducibility of estimated values than that obtained with semiquantitative methods.
肾活检中的慢性病变是包括狼疮性肾炎在内的肾脏疾病公认的预后因素。然而，用于评估慢性病变的方法很大程度上基于半定量评估，可能导致重复性差。观察者间差异在狼疮性肾炎中尤为重要，因为急性和慢性病变可能同时出现。在本研究中，我们使用20例肾活检标本和一种标准半定量方法，测试了三位病理学家（其中两位接受过肾脏病理学专门培训）对慢性病变评估的重复性。在第二个实验中，我们评估了两位肾脏病理学家对33例狼疮性肾炎活检标本中慢性病变评估的重复性。将半定量估计值与先前提出的用于定量肾活检中慢性病变的形态计量学方法得到的值进行比较。尽管估计值之间存在相关性，但使用半定量方法时变异范围很大。特别是，狼疮性肾炎的活动度和慢性度指数重复性很差。相比之下，使用形态计量学评分虽然不能消除观察者间的变异性，但与半定量方法相比，能使估计值的重复性更好。
