Role of renal biopsy in evaluation of morphological spectrum and pathogenesis of lupus nephritis
Keywords:
Immunofluorescence, Lupus nephritis, Pathogenesis, Renal biopsies
Abstract
Introduction: Lupus nephritis is a common complication in patients with systemic lupus erythematous (SLE) characterized by deposition of antibodies in glomerular, vascular and tubulointerstitial compartments of the kidney. International society of Nephrology/ Renal Pathology Society (ISN/RPS) 2003 classification plays an important role in the diagnosis and predicting prognosis in these cases. The aim of this study was to evaluate the morphological changes in renal biopsy and to correlate them with the pathogenesis of lupus nephritis.Methods: This was a cross sectional study of 50 renal biopsies of lupus nephritis from two tertiary care centers. Clinical data, lab findings, histopathology slides and immunofluorescence findings were retrieved and analysed by two senior pathologists. The activity and chronicity indices were calculated by each pathologist and were compared for inter observer variation. The activity index was correlated with immunofluorescence findings.Results: The mean age of patient was 29.75 years with M:F ratio of 1:9.The frequency of each class according to ISN/RPS classification was class I (0%),class II (20%),class III (2%),class IV (62%),class V (14%) and class VI (2%). All class IV cases were global and active with maximum activity indices. The mean of activity and chronicity indices of pathologist A was 8.83, 2.7 and pathologist B was 9.13, 1.9. High activity showed increased intensity (3+) of IgG and C3 staining on immunofluorescence.Conclusion: We found that activity and chronicity indices calculated on renal biopsy along with immunofluorescence findings can suggest the extent of pathogenesis of lupus nephritis. This can be useful for further management and follow up. DOI: 10.21276/APALM.1562References
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2. Sidiropoulos PI, Kritikos HD, Boumpas DT. Lupus nephritis flares .Lupus 2005;14(1):49-52
3. Hahn BH. Antibodies to DNA. NEJM 1998;338(19):1359–1368.
4. Weening JJ, D’agati D, Schwartz M, et al: The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004 ; 65:521–530,
5. Austin HA , Muenz LR, Joyce KM, et al: Diffuse proliferative lupus nephritis: Identification of specific pathologic features affecting renal outcome. Kidney Int 1984;25:689–95
6. Rahman A, Isenberg DA. Systemic lupus erythematosus. NEJM. 2008;358(9):929-39.
7. Mannik M, Merrill CE, Stamps LD, Wener MH. Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus. J of Rheumatology. 2003;30(7):1495–504.
8. Zhou W, Marsh JE, Sacks SH. Intrarenal synthesis of complement. Kidney International. 2001;59(4):1227–235.
9. Gomaa W, Bahlas S , HabhabW, MustaqM etal .Clinicopathological characteristic of lupus nephritis in western region of Saudi Arabia:An experience from two tertiary medical centers.Journal of Microscopy and Ultrastructure 2014;2:12-19
10. Qari.f Clinical pattern of systemic lupus erthematosus in Western Saudi Arabia ,Saudi Med J 2002;23:1247–250.
11. Heller T, AhmedM., SiddiqqiA., WallrauchC., BahlasS, Systemic lupus erythematosus in Saudi Arabia: morbidity and mortality in a multiethnic population Lupus, 2007;16:908–14
12. YokoyamaH., WadaT., HaraA., YamahanaJ., NakayaI., KobayashiM., et al. The outcome and a new ISN/RPS 2003 classification of lupus nephritis in JapaneseKidney Int 2004;66:2382–88.
13. JallouliM., FriguiM., HmidaM., MarzoukS., KaddourN., BahloulZ.Clinical and immunological manifestations of systemic lupus erythematosus: study on 146 south Tunisian patients. Saudi J Kidney Dis Transpl 2008;19:1001–8
14. Arfaj A., Khalil N., Al SalehS. Lupus nephritis among 624 cases of systemic lupus erythematosus in Riyadh, Saudi Arabia Rheumatol Int 2009;29: 1057–1067.
15. Huong D., Papo T., Beaufils H., Wechsler B., Bletry O., Baumelou A., et al. Renal involvement in systemic lupus erythematosus. A study of 180 patients from a single center Medicine (Baltimore)1999;78:148–66
16. Neumann K., Wallace D., Azen C., Nessim S., Fichman M., Metzger A., et al. Lupus in the 1980: III. Influence of clinical variables, biopsy, and treatment on the outcome in 150 patients with lupus nephritis seen at a single center Semin Arthritis Rheum1995;25:47–55
17. Seedat Y., Parag K., Ramsaroop R. Systemic lupus erythematosus and renal involvement. A South African experience Nephron1994;66:426–30
18. Shayakul C., Ong-aj-yooth L., ChirawongP., NimmannitS., ParichatikanondP., LaohapandT., et al. Lupus nephritis in Thailand: clinicopathologic findings and outcome in 569 patients Am J Kidney Dis 1995;26:300–307
19. NezhadS., SepaskhahR. Correlation of clinical and pathological findings in patients with lupus nephritis: a five-year experience in Iran Saudi J Kidney Dis Transpl 2008 ;19:32–40
20. Al AttiaH., Al AhmedY., Chandani A. Serological markers in Arabs with lupus nephritis Lupus 1998;7: 198–201
21. Al-JarallahK., Al-AwadiA., SiddiquiH., Al-SalimI., ShehabI., Umamaheswaran I. , et al. Systemic lupus erythematosus in Kuwait—hospital based study. Lupus 1998;7:434-8
22. LuF. Yu, TanY., WuL., ZhuN., LiuG., ZhaoM.. Class IV-G and IV-S lupus nephritis in Chinese patients: a large cohort study from a single center Lupus 2009;18:1073–10
23. HiramatsuN., KuroiwaT., IkeuchiT., MaeshimaA., KanekoY., HiromuraK., et al. Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions. Rheumatology (oxford) 2008;47:702-7
24. Guillermo AH. The valve of electron microscopy in the diagnosis and clinical management of lupus nephritis. Ultrastuct Pathol 1999;23:63-77.
25. Howie A , Turhan N., Adu D. Powerful morphometric indicator of prognosis in lupus nephritis. QJM. 2003;96(6):411–20.
26. Grcevska1 .L, Petrusevska2 .G, Dzikova. S, Polenakovic .M. Histopathological index of Activity and Chronicity :predictors of renal outcome in lupus nephritis .BANTAO journal 2003;1(2):138
27. Lai .F, Li .P, Choi .P, K. To, Wang .A, Leung .C, et al. Histological appraisal of lupus nephritis Hong Kong J Nephrol 2000;2:13–18
28. Ferluga D, Jerse M, Vizjak A, Rozman B, Kos-Golja M, Bren AF. Correlation among WHO classes, histomorphologic patterns of glomerulonephritis and glomerular immune deposits in SLE. Wien Klin Wochenschr.2000;112 :692-701.
29. Nossent H, Berden J, Swaak T. Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis. Lupus 2000;9(7):504-10.
2. Sidiropoulos PI, Kritikos HD, Boumpas DT. Lupus nephritis flares .Lupus 2005;14(1):49-52
3. Hahn BH. Antibodies to DNA. NEJM 1998;338(19):1359–1368.
4. Weening JJ, D’agati D, Schwartz M, et al: The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004 ; 65:521–530,
5. Austin HA , Muenz LR, Joyce KM, et al: Diffuse proliferative lupus nephritis: Identification of specific pathologic features affecting renal outcome. Kidney Int 1984;25:689–95
6. Rahman A, Isenberg DA. Systemic lupus erythematosus. NEJM. 2008;358(9):929-39.
7. Mannik M, Merrill CE, Stamps LD, Wener MH. Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus. J of Rheumatology. 2003;30(7):1495–504.
8. Zhou W, Marsh JE, Sacks SH. Intrarenal synthesis of complement. Kidney International. 2001;59(4):1227–235.
9. Gomaa W, Bahlas S , HabhabW, MustaqM etal .Clinicopathological characteristic of lupus nephritis in western region of Saudi Arabia:An experience from two tertiary medical centers.Journal of Microscopy and Ultrastructure 2014;2:12-19
10. Qari.f Clinical pattern of systemic lupus erthematosus in Western Saudi Arabia ,Saudi Med J 2002;23:1247–250.
11. Heller T, AhmedM., SiddiqqiA., WallrauchC., BahlasS, Systemic lupus erythematosus in Saudi Arabia: morbidity and mortality in a multiethnic population Lupus, 2007;16:908–14
12. YokoyamaH., WadaT., HaraA., YamahanaJ., NakayaI., KobayashiM., et al. The outcome and a new ISN/RPS 2003 classification of lupus nephritis in JapaneseKidney Int 2004;66:2382–88.
13. JallouliM., FriguiM., HmidaM., MarzoukS., KaddourN., BahloulZ.Clinical and immunological manifestations of systemic lupus erythematosus: study on 146 south Tunisian patients. Saudi J Kidney Dis Transpl 2008;19:1001–8
14. Arfaj A., Khalil N., Al SalehS. Lupus nephritis among 624 cases of systemic lupus erythematosus in Riyadh, Saudi Arabia Rheumatol Int 2009;29: 1057–1067.
15. Huong D., Papo T., Beaufils H., Wechsler B., Bletry O., Baumelou A., et al. Renal involvement in systemic lupus erythematosus. A study of 180 patients from a single center Medicine (Baltimore)1999;78:148–66
16. Neumann K., Wallace D., Azen C., Nessim S., Fichman M., Metzger A., et al. Lupus in the 1980: III. Influence of clinical variables, biopsy, and treatment on the outcome in 150 patients with lupus nephritis seen at a single center Semin Arthritis Rheum1995;25:47–55
17. Seedat Y., Parag K., Ramsaroop R. Systemic lupus erythematosus and renal involvement. A South African experience Nephron1994;66:426–30
18. Shayakul C., Ong-aj-yooth L., ChirawongP., NimmannitS., ParichatikanondP., LaohapandT., et al. Lupus nephritis in Thailand: clinicopathologic findings and outcome in 569 patients Am J Kidney Dis 1995;26:300–307
19. NezhadS., SepaskhahR. Correlation of clinical and pathological findings in patients with lupus nephritis: a five-year experience in Iran Saudi J Kidney Dis Transpl 2008 ;19:32–40
20. Al AttiaH., Al AhmedY., Chandani A. Serological markers in Arabs with lupus nephritis Lupus 1998;7: 198–201
21. Al-JarallahK., Al-AwadiA., SiddiquiH., Al-SalimI., ShehabI., Umamaheswaran I. , et al. Systemic lupus erythematosus in Kuwait—hospital based study. Lupus 1998;7:434-8
22. LuF. Yu, TanY., WuL., ZhuN., LiuG., ZhaoM.. Class IV-G and IV-S lupus nephritis in Chinese patients: a large cohort study from a single center Lupus 2009;18:1073–10
23. HiramatsuN., KuroiwaT., IkeuchiT., MaeshimaA., KanekoY., HiromuraK., et al. Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions. Rheumatology (oxford) 2008;47:702-7
24. Guillermo AH. The valve of electron microscopy in the diagnosis and clinical management of lupus nephritis. Ultrastuct Pathol 1999;23:63-77.
25. Howie A , Turhan N., Adu D. Powerful morphometric indicator of prognosis in lupus nephritis. QJM. 2003;96(6):411–20.
26. Grcevska1 .L, Petrusevska2 .G, Dzikova. S, Polenakovic .M. Histopathological index of Activity and Chronicity :predictors of renal outcome in lupus nephritis .BANTAO journal 2003;1(2):138
27. Lai .F, Li .P, Choi .P, K. To, Wang .A, Leung .C, et al. Histological appraisal of lupus nephritis Hong Kong J Nephrol 2000;2:13–18
28. Ferluga D, Jerse M, Vizjak A, Rozman B, Kos-Golja M, Bren AF. Correlation among WHO classes, histomorphologic patterns of glomerulonephritis and glomerular immune deposits in SLE. Wien Klin Wochenschr.2000;112 :692-701.
29. Nossent H, Berden J, Swaak T. Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis. Lupus 2000;9(7):504-10.
Published
2017-12-21
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