Austin H A, Muenz L R, Joyce K M, Antonovych T T, Balow J E
Kidney Int. 1984 Apr;25(4):689-95. doi: 10.1038/ki.1984.75.
Prerandomization renal biopsy specimens were examined in 102 patients upon entry into prospective therapeutic trials of lupus nephritis in an attempt to identify early predictors of renal failure outcome. All 11 renal failures occurred among the 72 individuals with diffuse proliferative or membranoproliferative glomerulonephritis (DPGN/MPGN); thus, these patients were at modestly, but significantly, increased risk of endstage renal disease compared to those with focal proliferative, membranous, or mesangial glomerulonephritis. Considering the low incidence of endstage renal disease among patients with DPGN/MPGN, we sought to refine the prognostic information obtained from renal morphology by semiquantitative scoring of individual histologic features and by derivation of composite histologic scores specified by Activity (AI) and Chronicity (CI) Indices. Among the 72 patients with DPGN/MPGN, the composite AI was more strongly predictive of renal failure than were the individual active histologic features; cellular crescents and extensive fibrinoid necrosis yielded positive associations, while endocapillary proliferation, leucocytic exudation, and hyaline thrombi in glomeruli and interstitial inflammation by themselves did not emerge as useful prognostic indicators. However, chronicity items (glomerular sclerosis, fibrous crescents, tubular atrophy, and interstitial fibrosis) considered individually, as well as in the composite CI, were highly predictive of renal failure outcome. Particularly striking was the prognostic value of tubular atrophy; all 11 renal failures were among the 43 patients with tubular atrophy on prerandomization renal biopsy. While no single pathologic variable improved outcome predictions among those with tubular atrophy, examination for interactions among variables revealed that glomerular sclerosis and cellular crescents had a synergistic effect which augmented the prognostic information derived from analysis of tubular atrophy alone.(ABSTRACT TRUNCATED AT 250 WORDS)
在102例患者进入狼疮性肾炎前瞻性治疗试验时，对其随机分组前的肾活检标本进行了检查，以试图确定肾衰竭结局的早期预测指标。所有11例肾衰竭均发生在72例弥漫性增殖性或膜增殖性肾小球肾炎（DPGN/MPGN）患者中；因此，与局灶性增殖性、膜性或系膜性肾小球肾炎患者相比，这些患者发生终末期肾病的风险虽略有增加，但具有显著差异。考虑到DPGN/MPGN患者中终末期肾病的发病率较低，我们试图通过对个体组织学特征进行半定量评分以及推导由活动指数（AI）和慢性指数（CI）指定的综合组织学评分，来完善从肾脏形态学获得的预后信息。在这72例DPGN/MPGN患者中，综合AI比个体活动性组织学特征更能强烈预测肾衰竭；细胞性新月体和广泛的纤维蛋白样坏死呈正相关，而肾小球内毛细血管内增生、白细胞渗出、透明血栓以及间质炎症本身并未成为有用的预后指标。然而，单独考虑以及综合CI中的慢性指标（肾小球硬化、纤维性新月体、肾小管萎缩和间质纤维化）对肾衰竭结局具有高度预测性。特别显著的是肾小管萎缩的预后价值；所有11例肾衰竭患者均在随机分组前肾活检时有肾小管萎缩，共43例。虽然在有肾小管萎缩的患者中没有单一病理变量能改善结局预测，但对变量间相互作用的检查显示，肾小球硬化和细胞性新月体具有协同作用，增强了仅从肾小管萎缩分析中得出的预后信息。（摘要截选至250词）
