Clinical Usefulness of a Prognostic Score in Histological Analysis of Renal Biopsy in Patients with Lupus Nephritis

Kojo, Shoichiro; Sada, Ken‐ei; Kobayashi, Mizuho; Maruyama, Masanobu; Maeshima, Yohei; Sugiyama, Hiroshi; Makino, Hírofumi

doi:10.3899/jrheum.080793

Cited by 31 publications

(36 citation statements)

References 14 publications

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“…1A). This was of great interest because crescent formation in human membranoproliferative lupus nephritis is indicative of severe glomerular injury and associated with decreased survival and adverse outcomes (1)(2)(3). Poly (I:C)-treated mice displayed significantly higher histological glomerular and interstitial scores, with crescent formation in 60% of glomeruli; crescents were not observed in glomeruli from spontaneously proteinuric mice (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Mesangial and endothelial cell proliferation and leukocyte infiltration are frequent findings of active disease. Extracapillary epithelial cell proliferation, which leads to the formation of a cellular crescent, is a less-frequent finding in human lupus nephritis; however, it is characteristic of severe glomerular injury and an indicator of poor prognosis (1)(2)(3). The underlying mechanisms of crescent formation in lupus nephritis are largely unknown.…”

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confidence: 99%

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Proliferative lesions and metalloproteinase activity in murine lupus nephritis mediated by type I interferons and macrophages

Triantafyllopoulou

Franzke

Seshan³

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

129

112

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Glomerulonephritis is a major cause of morbidity in patients with systemic lupus erythematosus. Although substantial progress has been made in the identification of pathogenic triggers that result in autoantibody production, little is known about the pathogenesis of aggressive proliferative processes that lead directly to irreversible glomerular damage and compromise of renal function. In this study, we describe a model of polyinosinic: polycytidylic acid-accelerated lupus nephritis in NZB/W mice that is characterized by severe glomerular proliferative lesions with de novo crescent formation, findings that are linked with decreased survival and adverse outcomes in lupus. Proliferative glomerulonephritis was associated with infiltrating kidney macrophages and renal expression of IFNinducible genes, matrix metalloproteinases (MMPs), and growth factors. Crescent formation and renal MMP and growth factor expression were dependent on renal macrophages that expressed Il10, MMPs, osteopontin, and growth factors, including Pdgfc and Hbegf. Infiltrating macrophages and renal MMP expression were induced by type I IFN. These findings reveal a role for type I IFNs and alternatively activated macrophages in aggressive proliferative lesions of lupus nephritis.alternative macrophages | kidney disease | polyinosinic: polycytidylic acid | systemic lupus erythematosus | tissue repair

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Proliferative lesions and metalloproteinase activity in murine lupus nephritis mediated by type I interferons and macrophages

Triantafyllopoulou

Franzke

Seshan³

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

129

112

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“…[8][9][10][11][12][13][14][15][16] One study done by Kim et al 11 was excluded from analysis because it reported renal flares as an outcome and did not provide data on the doubling of serum creatinine concentration or ESRD. Characteristics of the remaining eight studies are given in Table 1.…”

Section: Studies Includedmentioning

confidence: 99%

Segmental and Global Subclasses of Class IV Lupus Nephritis Have Similar Renal Outcomes

Haring

Rietveld

Brand

et al. 2012

Journal of the American Society of Nephrology

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Whether renal outcomes differ between the segmental and global subclasses of diffuse proliferative (class IV) lupus nephritis is unknown. In this meta-analysis, we searched the literature in MEDLINE, EMBASE, five registries of clinical trials, and selected cohort studies and randomized, controlled trials that used the 2003 International Society of Nephrology and Renal Pathology Society classification of lupus nephritis in adult patients. Our endpoint was the composite of doubling of serum creatinine concentration or ESRD. In the eight studies included in the final analysis, the incidence of this endpoint varied between 0% and 67%. A funnel plot and Egger's test did not suggest significant heterogeneity. The meta-analysis did not support a significant difference in renal outcome between the segmental (IV-S) and global (IV-G) subclasses (relative risk for class IV-G versus IV-S, 1.08; 95% confidence interval, 0.68-1.70). Meta-regression did not suggest that ethnicity or duration of follow-up influenced the association between histologic class and renal risk. In conclusion, the rate of doubling of serum creatinine concentration or of ESRD did not differ between patients with class IV-S and those with IV-G lupus nephritis.

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“…However, among those with persistent lesions at a second renal biopsy after induction therapy, there was better renal 10-year survival with IV-S lesions (63.6%) versus those with IV-G lesions (0%) (23). Furthermore, the IV-S biopsies had fewer immune deposits with more fibrinoid necrosis compared with IV-G. Other studies have also reported no significant difference in the outcome of IV-S and IV-G LN classes (11,24,25). In a study of 92 patients with LN who were reclassified according to the ISN/RPS 2003 criteria, renal function was more likely to deteriorate in IV-G than in IV-S patients.…”

Section: Does the Isn/rps Classification Help Prognosticate Outcome?mentioning

confidence: 80%

Lupus Nephritis

Giannico

Fogo

2013

Clinical Journal of the American Society of Nephrology

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SummaryMost patients with SLE develop kidney disease related to this systemic underlying disease process. Lupus nephritis is an important cause of morbidity and even mortality in patients with systemic lupus erythematosus. Lupus nephritis has diverse morphologic manifestations with varying clinical presentations and consequences. The pathogeneses involve immune complexes, which can deposit anywhere in the kidney, and other mechanisms, including endothelial injury, podocytopathy, and tubulointerstitial injury. Treatment and prognosis accordingly range from excellent even with only observation with minimal mesangial deposits, to kidney failure despite aggressive immunosuppression in patients with severe proliferative disease. Renal biopsy plays a crucial role in the diagnosis of the specific form of lupus nephritis in any patient. However, the role of the renal biopsy in prediction of outcome, treatment, and prognosis has been controversial. We will review the current classification of lupus nephritis and the value of renal biopsy in the management of these patients.

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Clinical Usefulness of a Prognostic Score in Histological Analysis of Renal Biopsy in Patients with Lupus Nephritis

Abstract: These results demonstrate the advantage of our prognostic score compared to subclasses in predicting the renal outcome of class IV patients [University Hospital Medical Information Network (UMIN) clinical trials registry, number UMIN 000001943].

Cited by 31 publications

References 14 publications

Proliferative lesions and metalloproteinase activity in murine lupus nephritis mediated by type I interferons and macrophages

Proliferative lesions and metalloproteinase activity in murine lupus nephritis mediated by type I interferons and macrophages

Segmental and Global Subclasses of Class IV Lupus Nephritis Have Similar Renal Outcomes

Lupus Nephritis

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