Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.
Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan.
Lupus. 2021 Oct;30(11):1739-1746. doi: 10.1177/09612033211034234. Epub 2021 Jul 20.
The revision of International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification guidelines for lupus nephritis (LN) was suggested by a working group, who recommended a modified National Institute of Health (NIH) activity and chronicity scoring system to evaluate active and chronic LN lesions. However, whether this approach was useful for estimating long-term prognosis for LN patients is unclear.
We conducted a retrospective cohort study in Japanese subjects with biopsy-proven LN, between 1977 and 2018. Pathologic lesions were evaluated based on ISN/RPS 2003 classifications and the modified NIH scoring system. Patients were grouped by activity index (low, 0-5; moderate, 6-11; high, 12-24), and chronicity index (low, 0-2; moderate, 3-5; high, 6-12). The primary outcome was a composite of end-stage kidney disease (ESKD) or all-cause death, and the secondary outcome was ESKD alone.
Sixty-six subjects with a median age of 31 years were included. During median follow-up (11.5 years), 15 patients reached the primary outcome: 10 had ESKD, four had died, and one had ESKD and died. Kaplan-Meier analysis showed that the cumulative primary outcome incidence increased with a higher chronicity index (log-rank trend < 0.001). From multivariable survival analysis, moderate (hazard ratio [HR] 6.17, 95% confidence interval [CI] 1.14 to 33.20; = 0.034) and high chronicity indices (HR 20.20, 95% CI 1.13 to 359.82; = 0.041) were risk factors for the primary outcome.
Moderate and high chronicity indices were associated with an increased ESKD risk for LN.
国际肾脏病学会/肾脏病理学会（ISN/RPS）狼疮肾炎（LN）分类指南的修订是由一个工作组建议的，他们推荐改良的美国国立卫生研究院（NIH）活动和慢性评分系统来评估活动性和慢性 LN 病变。然而，这种方法是否有助于估计 LN 患者的长期预后尚不清楚。
我们对 1977 年至 2018 年间接受过 LN 活检的日本患者进行了回顾性队列研究。根据 ISN/RPS 2003 分类和改良 NIH 评分系统评估病理病变。根据活动指数（低，0-5；中，6-11；高，12-24）和慢性指数（低，0-2；中，3-5；高，6-12）对患者进行分组。主要结局是终末期肾病（ESKD）或全因死亡的复合结局，次要结局是 ESKD 单独。
共纳入 66 例患者，中位年龄 31 岁。中位随访（11.5 年）期间，15 例患者达到主要结局：10 例发生 ESKD，4 例死亡，1 例 ESKD 并死亡。Kaplan-Meier 分析显示，慢性指数较高者累积主要结局发生率增加（对数秩趋势 <0.001）。多变量生存分析显示，中度（HR 6.17，95%CI 1.14 至 33.20；=0.034）和高度慢性指数（HR 20.20，95%CI 1.13 至 359.82；=0.041）是主要结局的危险因素。
中度和高度慢性指数与 LN 的 ESKD 风险增加相关。
