Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Rheumatol Int. 2012 Aug;32(8):2459-64. doi: 10.1007/s00296-011-1986-8. Epub 2011 Jul 16.
Lupus nephritis (LN) class II has generally been considered a mild form of LN with a good response to treatment. Although the number was small, there have also been reports on later progression to class III or IV, resulting in poor renal and patient outcome. This study aims to review cases of LN class II to analyze differences between cases that progressed to class III or IV and cases that did not. We retrospectively analyzed 15 cases of LN class II among 277 cases of biopsy-proven lupus nephritis diagnosed in a tertiary medical center over about 14 years. Among the 15 patients, 5 patients progressed to class III or IV. Biopsy specimens were reviewed by a pathologist according to the ISN/RPS 2003 classification. Response to treatment was evaluated at 6 months after treatment. On fluorescence microscopy (IF), there was significantly higher degree of deposition in the glomeruli of IgM, IgA and C4 in the progression group than in the non-progression group. At 6 months after treatment, there was a trend toward higher rates of complete remission in the non-progression group (90%) compared with those in the progression group (40%, p = 0.077). Five of the 15 cases of ISN/RPS 2003 class II glomerulonephritis progressed to class III or IV over a mean of 5 years. The degree of immune-complex deposition for IgM, IgA and C4 in the glomeruli was significantly higher in the progression group.
狼疮性肾炎（LN）II 级通常被认为是一种轻度 LN，对治疗有良好的反应。尽管数量较少，但也有报道称其后来进展为 III 级或 IV 级，导致肾脏和患者预后不良。本研究旨在回顾 LN II 级病例，分析进展为 III 级或 IV 级的病例与未进展的病例之间的差异。我们回顾性分析了在一家三级医疗中心 14 年左右诊断的 277 例经活检证实的狼疮性肾炎中 15 例 LN II 级病例。在 15 例患者中，有 5 例进展为 III 级或 IV 级。病理学家根据 ISN/RPS 2003 分类对活检标本进行了复查。在治疗后 6 个月评估治疗反应。在荧光显微镜（IF）下，进展组肾小球中 IgM、IgA 和 C4 的沉积程度明显高于非进展组。在治疗后 6 个月，非进展组完全缓解率（90%）高于进展组（40%，p=0.077）。在 15 例 ISN/RPS 2003 2 级肾小球肾炎中，有 5 例在平均 5 年内进展为 III 级或 IV 级。进展组肾小球中 IgM、IgA 和 C4 的免疫复合物沉积程度明显更高。
