Comparison of the 2018 and 2003 International Society of Nephrology/Renal Pathology Society classification in terms of renal prognosis in patients of lupus nephritis: a retrospective cohort study

Abstract

Background Although the 2018 revised International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification was proposed recently, until now, no reports have been made comparing the association of renal prognosis between the 2018 revised ISN/RPS classification and the 2003 ISN/RPS classification. The present study aimed to assess the usefulness, especially of activity and chronicity assessment, of the 2018 revised ISN/RPS classification for lupus nephritis (LN) in terms of renal prognosis compared to the classification in 2003. Methods We retrospectively collected medical records of 170 LN patients from the database of renal biopsy at Fujita Health University from January 2003 to April 2019. Each renal biopsy specimen was reevaluated according to both the 2003 ISN/RPS classification and the 2018 revised ISN/RPS classification. Renal endpoint was defined as a 30% decline of estimated glomerular filtration rate (eGFR). Results A total of 129 patients were class III/IV±V (class III, 44 patients; class IV, 35 patients; class III/IV+V, 50 patients). The mean age was 42 years, 88% were female, and the median observation period was 50.5 months. Renal prognosis was significantly different among the classes and significantly poor in the patients with higher modified National Institute of Health (mNIH) chronicity index (C index, ≥ 4) by a log-rank test (p = 0.05 and p = 0.02, respectively). By Cox proportional hazard models, only the C index was significantly associated with renal outcome (hazard ratio 1.32, 95% CI 1.11–1.56, p ≤ 0.01), while the classes, the 2003 activity and chronicity subdivision, and the mNIH activity index had no significant association with renal outcome. Each component of the C index was significantly associated with renal outcome in different models. Conclusion This study demonstrates that the 2018 revised ISN/RPS classification was more useful in terms of association with renal prognosis compared to the 2003 ISN/RPS classification.

Searching for a prognostic index in lupus nephritis

“…Several studies have shown that tubular atrophy and interstitial fibrosis were independent factors for poor renal evolution [ 16 – 23 ] as well as the chronicity index [ 24 ]. Tang et al [ 25 ] have developed and validated a risk score for the development of ESRD in LN, emphasizing the importance of tubulointerstitial lesions (tubular atrophy and interstitial fibrosis) than the histological subtype according to the ISN/RPS classification [ 26 ].…”

Histologic evaluation of activity and chronicity of lupus nephritis and its clinical significance

“…We think it is possible that the clear distinction between the types of crescents was the reason for the increased correlation of the modified CI with outcomes. Umeda et al [34]…”

“…We think it is possible that the clear distinction between the types of crescents was the reason for the increased correlation of the modified CI with outcomes. Umeda et al [ 34 ] also performed a retrospective comparison of the original and revised ISN/RPS classifications, including the NIH indices, at a single Japanese institution. They compared the modified NIH indices with the A, C, and A/C subclasses of the original ISN/RPS classification in terms of their correlation with a 30% decline in eGFR.…”

C3dg and MAC complement depositions in the renal histopathology of patients with lupus nephropathy

“…LN was classified according to the ISN/RPS 2018 LN classification system by two experienced renal pathologists (HL and GL) who also scored the indicators independently based on the average score according to the activity index of renal tissue in lupus nephropathy (17). The intensity of immunostaining was reported by GL and blindly assessed by HL.…”