Kim Taeyeong, Kwak Yooujin, Lee Jun Young, Shin Hanwul, Kim Jae Seok, Yang Jae Won, Eom Minseob
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Kidney Res Clin Pract. 2022 Sep;41(5):545-555. doi: 10.23876/j.krcp.22.123. Epub 2022 Sep 30.
Diabetic nephropathy (DN) accounts for approximately half of all cases of chronic kidney disease (CKD) and end-stage kidney disease worldwide. The Renal Pathology Society (RPS) classification has been used to predict the renal prognosis in DN. In 2018, the Japanese Renal Pathology Society (JRPS) proposed a comprehensive classification system that included pathological changes in the kidney. The clinical significance of the JRPS classification system was comparatively evaluated in the present study.
A total of 93 cases diagnosed with DN from 2009 to 2019 were enrolled. JRPS scores (J-scores) were calculated by scoring the pathological factors in the JRPS classification system and comparing them with clinical parameters.
Most pathological factors constituting the J-score were significantly correlated with clinical factors. Laminated nodules were inversely correlated with estimated glomerular filtration rate. After adjusting for age, sex, body mass index, hemoglobin A1c, diabetes duration, and hypertension, CKD stage was significantly correlated with JRPS grade, nodular lesions, and exudative lesions in the multivariate logistic regression analysis. However, receiver operating characteristic curve analysis revealed that the J-score (area under the curve [AUC] = 0.639) had lower clinical significance than the traditional RPS classification system (AUC = 0.675).
The JRPS classification can more comprehensively reflect renal changes than the RPS classification and is correlated with renal survival. When creating a new pathological classification, arteriolar hyalinosis should not be included, whereas laminated nodules should be included.
糖尿病肾病（DN）约占全球慢性肾脏病（CKD）和终末期肾病所有病例的一半。肾脏病理学会（RPS）分类已用于预测DN的肾脏预后。2018年，日本肾脏病理学会（JRPS）提出了一个包括肾脏病理变化的综合分类系统。本研究对JRPS分类系统的临床意义进行了比较评估。
纳入2009年至2019年诊断为DN的93例患者。通过对JRPS分类系统中的病理因素进行评分并与临床参数进行比较来计算JRPS评分（J评分）。
构成J评分的大多数病理因素与临床因素显著相关。分层结节与估计肾小球滤过率呈负相关。在调整年龄、性别、体重指数、糖化血红蛋白、糖尿病病程和高血压后，在多因素逻辑回归分析中，CKD分期与JRPS分级、结节性病变和渗出性病变显著相关。然而，受试者工作特征曲线分析显示，J评分（曲线下面积[AUC]=0.639）的临床意义低于传统的RPS分类系统（AUC=0.675）。
与RPS分类相比，JRPS分类能更全面地反映肾脏变化，且与肾脏生存率相关。在创建新的病理分类时，不应包括小动脉玻璃样变，而应包括分层结节。
