Oni L, Beresford M W, Witte D, Chatzitolios A, Sebire N, Abulaban K, Shukla R, Ying J, Brunner H I
1 Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
2 Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Lupus. 2017 Oct;26(11):1205-1211. doi: 10.1177/0961203317706558. Epub 2017 May 7.
The gold standard for the classification of lupus nephritis is renal histology but reporting variation exists. The aim of this study was to assess the inter-observer variability of the 2003 International Society of Nephrology/Royal Pathology Society (ISN/RPS) lupus nephritis histological classification criteria in children. Histopathologists from a reference centre and three tertiary paediatric centres independently reviewed digitalized renal histology slides from 55 children with lupus nephritis. Histological ISN/RPS Class was assigned and features scored; lupus nephritis-activity [scored 0-24], lupus nephritis-chronicity [0-12] and tubulointerstitial activity [0-21]. In the cohort (73% females), the age at the time of biopsy was 15.5 ± 0.39 (mean ± standard error) years. Based on the reference centre, 42% (23/55) had ISN/RPS Class IV with lupus nephritis-activity score 4.23 ± 0.50, lupus nephritis-chronicity 1.81 ± 0.18 and tubulointerstitial activity 4.45 ± 0.35. There were 4-54 (mean 16.7) glomeruli per biopsy. Pathologists had fair agreement for ISN/RPS assignment (kappa; 0.26 ± 0.12), lupus nephritis-chronicity (intra-class correlation 0.36 ± 0.09) and tubulointerstitial activity (0.22 ± 0.09) scores. There was good agreement for lupus nephritis-activity scores (intra-class correlation 0.69 ± 0.06). When categorized into proliferative and non-proliferative disease, poor agreement among sites remained (kappa 0.24 ± 0.11). Despite unified criteria for the interpretation of histological features of lupus nephritis, marked reporting variation remains in clinical practice. As proliferative lupus nephritis is managed more intensively, this may influence renal outcomes.
狼疮性肾炎分类的金标准是肾脏组织学检查，但报告存在差异。本研究的目的是评估2003年国际肾脏病学会/皇家病理学会（ISN/RPS）狼疮性肾炎组织学分类标准在儿童中的观察者间变异性。来自一个参考中心和三个三级儿科中心的组织病理学家独立审查了55例狼疮性肾炎患儿的数字化肾脏组织学切片。确定了组织学ISN/RPS分级并对特征进行评分；狼疮性肾炎活动度（评分0 - 24）、狼疮性肾炎慢性度（0 - 12）和肾小管间质活动度（0 - 21）。在该队列中（73%为女性），活检时的年龄为15.5±0.39（均值±标准误）岁。基于参考中心，42%（23/55）的患儿为ISN/RPS IV级，狼疮性肾炎活动度评分为4.23±0.50，狼疮性肾炎慢性度为1.81±0.18，肾小管间质活动度为4.45±0.35。每次活检有4 - 54个（平均16.7个）肾小球。病理学家在ISN/RPS分级（kappa值；0.26±0.12）、狼疮性肾炎慢性度（组内相关系数0.36±0.09）和肾小管间质活动度（0.22±0.09）评分方面一致性一般。狼疮性肾炎活动度评分一致性良好（组内相关系数0.69±0.06）。当分为增殖性和非增殖性疾病时，各中心之间的一致性仍然较差（kappa值0.24±0.11）。尽管狼疮性肾炎组织学特征的解读有统一标准，但临床实践中报告差异仍然显著。由于增殖性狼疮性肾炎的治疗更为强化，这可能会影响肾脏预后。
