Kiremitci Saba, Ensari Arzu
Pathology Department, Medical School of Ankara University, Sihhiye, 06100 Ankara, Turkey.
ScientificWorldJournal. 2014;2014:580620. doi: 10.1155/2014/580620. Epub 2014 Dec 8.
The role of the renal biopsy in lupus nephritis is to provide the diagnosis and to define the parameters of prognostic and therapeutic significance for an effective clinicopathological correlation. Various classification schemas initiated by World Health Organization in 1974 have been proposed until the most recent update by International Society of Nephrology/Renal Pathology Society in 2004. In this paper, we reviewed the new classification system with the associated literature to highlight the benefits and the weak points that emerged so far. The great advantage of the classification emerged to provide a uniform reporting for lupus nephritis all over the world. It has provided more reproducible results from different centers. However, the studies indicated that the presence of glomerular necrotizing lesion was no longer significant to determine the classes of lupus nephritis leading to loss of pathogenetic diversity of the classes. Another weakness of the classification that also emerged in time was the lack of discussions related to the prognostic significance of tubulointerstitial involvement which was not included in the classification. Therefore, the pathogenetic diversity of the classification still needs to be clarified by additional studies, and it needs to be improved by the inclusion of the tubulointerstitial lesions related to prognosis.
肾活检在狼疮性肾炎中的作用是进行诊断，并确定具有预后和治疗意义的参数，以实现有效的临床病理关联。自1974年世界卫生组织提出各种分类方案以来，直至2004年国际肾脏病学会/肾脏病理学会的最新更新，已有多种分类方案。在本文中，我们回顾了新的分类系统及相关文献，以突出目前已显现的优点和不足。该分类的一大优势在于为全球狼疮性肾炎提供了统一的报告方式，不同中心能得出更具可重复性的结果。然而，研究表明肾小球坏死性病变的存在对于确定狼疮性肾炎的类别已不再具有显著意义，这导致各分类的发病机制多样性丧失。随着时间推移出现的该分类的另一个不足是缺乏对肾小管间质受累预后意义的讨论，而这并未包含在分类中。因此，该分类的发病机制多样性仍需通过更多研究加以阐明，且需要纳入与预后相关的肾小管间质病变来加以完善。
