Abstract:

ABSTRACT Objective: To observe the clinicopathological features and renal outcomes between class III and class III+V, class IV and class IV+V, and subclass IV-S and IV-G of patients with lupus nephritis. Methodology: The records of all adult patients with biopsy-proven class III, class III+V, class IV and class IV+V lupus nephritis in the Nanjing Glomerulonephritis Registry followed for at least one year were reviewed. All patients were pathologically classified according to the 2003 International Society of Nephrology/Renal Pathological Society (ISN/RPS) classification system. Results: The levels of proteinuria and histological chronic lesions were severe, while the histological acute lesions were mild in patients with class III+V and IV+V was severe than those in patients with simple class III and IV. The rate of serum ANCA was higher, while the degree of hypertension, proteinuria and hypocomplementemia were lower in patients with class IV-S than those in patients with IV-G. The histological lesions of segmental necrosis and crescentic formation were severe, while the lesions of platinum loop and endocapillary proliferation were mild in patients with class IV-S than those in patients with IV-G The 10- and 20-year renal survival rates of LN patients with class III were 92.1% and 72.2%; with class III+V, 91.5% and 88.9%; with class IV, 82.7% and 60.3% (with subclass IV-S, 86.2% and 69.6%; with subclass IV-G, 81.9% and 58.9%); with class IV+V, 82.7% and 54.7%; with class V, 96.8% and 83.8%. Conclusions: Proliferative lesions combined with membranous lesions presented with both clinicopathological characteristics of the two types of lesions, but their renal outcomes were not different from proliferative lesions alone. Subclass IV-S and IV-G had their own characteristics respectively, but the division of class IV into the two subclasses was not meaningful for predicting renal outcomes.

Key words: lupus nephritis, renal outcome, pathological classification