Roberts Ian S D, Cook H Terence, Troyanov Stéphan, Alpers Charles E, Amore Alessandro, Barratt Jonathan, Berthoux Francois, Bonsib Stephen, Bruijn Jan A, Cattran Daniel C, Coppo Rosanna, D'Agati Vivette, D'Amico Giuseppe, Emancipator Steven, Emma Francesco, Feehally John, Ferrario Franco, Fervenza Fernando C, Florquin Sandrine, Fogo Agnes, Geddes Colin C, Groene Hermann-Josef, Haas Mark, Herzenberg Andrew M, Hill Prue A, Hogg Ronald J, Hsu Stephen I, Jennette J Charles, Joh Kensuke, Julian Bruce A, Kawamura Tetsuya, Lai Fernand M, Li Lei-Shi, Li Philip K T, Liu Zhi-Hong, Mackinnon Bruce, Mezzano Sergio, Schena F Paolo, Tomino Yasuhiko, Walker Patrick D, Wang Haiyan, Weening Jan J, Yoshikawa Nori, Zhang Hong
Department of Cellular Pathology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
Kidney Int. 2009 Sep;76(5):546-56. doi: 10.1038/ki.2009.168. Epub 2009 Jul 1.
Pathological classifications in current use for the assessment of glomerular disease have been typically opinion-based and built on the expert assumptions of renal pathologists about lesions historically thought to be relevant to prognosis. Here we develop a unique approach for the pathological classification of a glomerular disease, IgA nephropathy, in which renal pathologists first undertook extensive iterative work to define pathologic variables with acceptable inter-observer reproducibility. Where groups of such features closely correlated, variables were further selected on the basis of least susceptibility to sampling error and ease of scoring in routine practice. This process identified six pathologic variables that could then be used to interrogate prognostic significance independent of the clinical data in IgA nephropathy (described in the accompanying article). These variables were (1) mesangial cellularity score; percentage of glomeruli showing (2) segmental sclerosis, (3) endocapillary hypercellularity, or (4) cellular/fibrocellular crescents; (5) percentage of interstitial fibrosis/tubular atrophy; and finally (6) arteriosclerosis score. Results for interobserver reproducibility of individual pathological features are likely applicable to other glomerulonephritides, but it is not known if the correlations between variables depend on the specific type of glomerular pathobiology. Variables identified in this study withstood rigorous pathology review and statistical testing and we recommend that they become a necessary part of pathology reports for IgA nephropathy. Our methodology, translating a strong evidence-based dataset into a working format, is a model for developing classifications of other types of renal disease.
当前用于评估肾小球疾病的病理分类通常基于观点,建立在肾脏病理学家对历史上认为与预后相关的病变的专家假设之上。在此,我们开发了一种独特的方法用于肾小球疾病IgA肾病的病理分类,其中肾脏病理学家首先进行了广泛的迭代工作,以定义具有可接受的观察者间再现性的病理变量。在这些特征组密切相关的情况下,根据对抽样误差的敏感性最低以及在常规实践中评分的难易程度进一步选择变量。这一过程确定了六个病理变量,然后可用于独立于IgA肾病临床数据来探究预后意义(在随附文章中描述)。这些变量为:(1)系膜细胞评分;显示(2)节段性硬化、(3)毛细血管内细胞增多、或(4)细胞性/纤维细胞性新月体的肾小球百分比;(5)间质纤维化/肾小管萎缩百分比;最后是(6)动脉硬化评分。个体病理特征的观察者间再现性结果可能适用于其他肾小球肾炎,但尚不清楚变量之间的相关性是否取决于肾小球病理生物学的具体类型。本研究中确定的变量经受住了严格的病理学审查和统计检验,我们建议它们成为IgA肾病病理报告的必要组成部分。我们将基于有力证据的数据集转化为实用形式的方法,是开发其他类型肾脏疾病分类的一个范例。