Abstract:

ABSTRACT Objective: This study aimed to determine the differences in clinicopathological features and outcome between segmental and global LN. Methodology: Forty-two patients with biopsy-proven segmental LN (Class IVS group) and 115 with global LN (Class IVG group) were identified and retrospectively analyzed. Classification criteria were modified in our study. Class IVS LN was defined as ≥50% of glomeruli manifesting crescents or fibrinoid necrosis, and the uninvolved glomerular and capillary loop were normal. Class IVG LN was defined as ≥50% of the glomeruli manifested as endocapillary proliferation involving the whole glomerular without fibrinoid necrosis or crescent. Results:（1）Class IVS had significantly higher complement C3 (0.493 vs 0.355g/L, P<0.01) and C4 (0.111 vs 0.065g/L, P<0.01) than Class IVG. The proportion of low complement C4 in IVS group was significantly lower than in IVG group (50.0% vs 80.9%, P<0.01).（2）Wire loop(0% vs 42.6%, P<0.01) and hyaline thrombi(2.4% vs 36.5%, P<0.01) were significantly rare in IVS than in IVG group.（3）The complete remission (CR) rate within 6 months was significantly lower in the IVS(33.3% vs 53.0%, P=0.029) than in IVG group. CR rate within 6 months of IVCY+IVS group(18.8% vs 52.7%, P=0.016) was significantly lower than that of IVCY+IVG group. The 10-year survival without renal function deterioration in IVS group was significantly inferior than that in IVG group(70.4% vs 97.1%, P=0.015). Conclusions:. Compared to global LN, segmental LN demonstrated a “panic-immune-complex deposit” pathology, a dissatisfied response to traditional immunosuppressant and a poorer prognosis, suggesting different pathogenesis may exsit.

Key words: lupus nephritis, classification, pathology, prognosis