Chow Tak-Kuan, Looi Lai-Meng, Cheah Phaik-Leng
University of Malaya, Faculty of Medicine, Department of Pathology, 50603 Kuala Lumpur, Malaysia.
Malays J Pathol. 2015 Dec;37(3):239-46.
In the past, lupus nephritis was histologically classified according to the 1995 WHO Classification. With the introduction of the 2003 ISN/RPS Classification, many nephropathology services converted to this new classification. This study was undertaken to compare both classification systems in a single centre practice.
103 consecutive adequate renal biopsies initially reported as lupus nephritis in the Department of Pathology, Faculty of Medicine, University of Malaya were reassessed using the criteria of both the 1995 WHO Classification and the 2003 ISN/ RPS Classification.
The relative prevalence for each class using the WHO Classification were: Class I (1%), Class II (8.7%), Class III (6.8%), Class IV (60.2%), Class V (20.4%), Class VI (2.9%) while the prevalence using the 2003 ISN/RPS Classification were: Class I (1%), Class II (8.7%), Class III (6.8%), Class IV (61.2%), Class V (21.3%), Class VI (1%). Both classifications were essentially comparable with regards to Classes I, II and III. The differences in Classes IV, V and VI were significant in potential to alter patient management. The identification of segmental lesions (Class IV-S) over and above a global nephritis (Class IV-G) deserves more focused clinicopathological studies to gauge whether these groups have different clinical manifestations and outcomes. With regards Class V, the ISN/RPS system, by requiring that all mixed classes be stipulated in the diagnostic line, minimizes the chances of patients missing out on additional treatment. The ISN/ RPS system has stricter criteria for Class VI, which again minimizes patients missing out on therapy. On the whole, the ISN/RPS system is more user-friendly as criteria are more clearly defined which translates to more benefits to patient care.
过去，狼疮性肾炎是根据1995年世界卫生组织（WHO）分类进行组织学分类的。随着2003年国际肾脏病学会/肾脏病理学会（ISN/RPS）分类的引入，许多肾脏病理服务机构转而采用这种新分类。本研究旨在比较单一中心实践中这两种分类系统。
对马来西亚大学医学院病理科最初报告为狼疮性肾炎的103例连续充分肾活检标本，采用1995年WHO分类标准和2003年ISN/RPS分类标准进行重新评估。
使用WHO分类时各类型的相对患病率为：I类（1%），II类（8.7%），III类（6.8%），IV类（60.2%），V类（20.4%），VI类（2.9%）；而使用2003年ISN/RPS分类时的患病率为：I类（1%），II类（8.7%），III类（6.8%），IV类（61.2%），V类（21.3%），VI类（1%）。I、II和III类在两种分类中基本可比。IV、V和VI类的差异在改变患者管理的可能性方面具有显著性。除弥漫性肾炎（IV-G类）外，节段性病变（IV-S类）的识别值得更深入的临床病理研究，以评估这些组是否具有不同的临床表现和预后。关于V类，ISN/RPS系统要求在诊断行中规定所有混合类型，从而将患者错过额外治疗的机会降至最低。ISN/RPS系统对VI类有更严格的标准，这同样减少了患者错过治疗的情况。总体而言，ISN/RPS系统更便于使用，因为标准定义更清晰，这对患者护理更有益。
