Tinajero-Sánchez Denisse N, Zúñiga-González Erick Y, Zavala-Miranda María F, Hernández-Andrade Adriana, Navarro-Sánchez Valeria, Nordmann-Gomes Alberto, Rivero-Otamendi Emiliano, Uribe-Uribe Norma O, Mejia-Vilet Juan M
Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Pathology and Anatomic Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Rheumatology (Oxford). 2025 Aug 1;64(8):4787-4795. doi: 10.1093/rheumatology/keaf194.
There is a call to improve the histological classification of LN. We assessed the association between histological lesions and kidney outcomes.
We assessed 430 participants with biopsy-proven LN diagnosed between 2008 and 2020. All participants had follow-up for ≥3 years. The activity and chronicity lesions comprised in the National Institutes of Health activity and chronicity indices were evaluated for its association with complete response (CR), kidney relapses and end-stage kidney disease (ESKD) by time-to-event analyses. Likelihood ratios (LRs) were calculated to define the optimal cut-offs for each parameter.
Activity lesions weakly correlated with clinical parameters at LN flare, but none was associated with time to response or progression to ESKD. Chronicity lesions, except segmental glomerular sclerosis (HR 0.97, 95% CI 0.90-1.05 for CR, and HR 1.11, 95% CI 0.99-1.25 for ESKD), were associated with time to complete and partial response and progression to ESKD. Excluding segmental glomerular sclerosis from the chronicity index did not modify its prognostic yield (C-statistic 0.66 and 0.67 for CR and 0.74 and 0.74 for ESKD). Newer cut-offs for each chronicity item were defined by the positive and negative LR ≥3.0 or ≤0.33, respectively: 0-15%, 16-30%, >30% for interstitial fibrosis/tubular atrophy and 0-5%, 6-30%, >30% for global glomerular sclerosis.
Chronicity lesions in the kidney biopsy, except segmental glomerular sclerosis, are associated with time to complete/partial remission and progression to ESKD. We propose eliminating segmental glomerular sclerosis from the chronicity index and using LRs to define the cut-offs for each histological lesion.
人们呼吁改进狼疮性肾炎（LN）的组织学分类。我们评估了组织学病变与肾脏预后之间的关联。
我们评估了430名在2008年至2020年间经活检证实为LN的参与者。所有参与者均随访了≥3年。通过事件发生时间分析，评估美国国立卫生研究院活动指数和慢性指数中的活动和慢性病变与完全缓解（CR）、肾脏复发和终末期肾病（ESKD）的关联。计算似然比（LRs）以确定每个参数的最佳临界值。
活动病变与LN发作时的临床参数弱相关，但均与缓解时间或进展至ESKD无关。慢性病变，除节段性肾小球硬化外（CR的HR为0.97，95%CI为0.90 - 1.05；ESKD的HR为1.11，95%CI为0.99 - 1.25），与完全和部分缓解时间以及进展至ESKD相关。从慢性指数中排除节段性肾小球硬化并未改变其预后价值（CR的C统计量为0.66和0.67，ESKD的C统计量为0.74和0.74）。每个慢性项目的新临界值分别由阳性和阴性LR≥3.0或≤0.33定义：间质纤维化/肾小管萎缩为0 - 15%、16 - 30%、>30%；全球肾小球硬化为0 - 5%、6 - 30%、>30%。
肾脏活检中的慢性病变，除节段性肾小球硬化外，与完全/部分缓解时间以及进展至ESKD相关。我们建议从慢性指数中剔除节段性肾小球硬化，并使用LRs来定义每个组织学病变 的临界值。
