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Immunopatologia renale

The value of repeat biopsy(RB) in the management of lupus nephritis(LN):international study on 142 cases.

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Razionale

 The INS/RPS classification of LN pointed out more a qualitative(segmental-global) than quantitative(</>50%) factors.A  RB  could be usefull for a better clinical-pathological understanding of LN. The aim of  the present international multi-centric study was to give a validation of ISN/RPS classification and the predictive value of  RB.

Casistica e Metodi

This multi-centric retrospective study included 142 patients with histological diagnosis of LN. Proteinuria,  creatinine and blood pressure  at the time of the first biopsy(FB) and RB were available. All the histological diagnoses (FB and RB) were centrally reviewed .

Risultati

 At FB  12.7% cases were histologically classified as Class II,  10.6%  Class III,  4.9%  Class IV-S,  40.9%   Class IV-G ,  16.9%  . At  FB,  severe mesangial proliferation was present in 26,67% class III ,  35.7%  class IV-S 94.8%   class IV-G   (p<.001). Tuft necrosis was present in 13,3%  class III ,   42.8% class IV-S and 6.8%  class IV-G (p<.005). Wire loops were absent in class III  ,  14.29%  class IV-S and  75.86%  class IV-G (p<.001).Similar differences were present at RB. The correlation between clinical variables and histological classes at FB and RB demostrated a much severe renal symptoms  in class IV-G at FB and RB.

The correlation between ISN/RPS classification at FB and RB is reported in Tab 1. The data demonstrated that the transformation among segmental (III-IV-S) and “mesangial” forms (II-IV-G) was extremely rare. The correlations between different classes and clinical parameters at the final follow-up from FB and RB suggest that  classes correlate modestly with clinical evolution at FB but strongly at RB

Conclusioni

Data suggest that clear morphological differences between segmental  and global forms are possible expression of different pathogenetic mechanisms with also definite clinical differences and  do not represent a simple continuum of disease.

 RB, in a large cohort of patients  provide more predictive  informations relevant to long term renal outcome than baseline biopsy.

 

 

Ferrario F*,Pagni F*,Galimberti S**,Basciu M**,Malachina S*,Pilla D*.
(*Centro di Nefropatologia,Ospedale San Gerardo-Monza,Università Bicocca -Milano **Dipartimento di Statistica,Università Bicocca-Milano )
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Realizzazione: Tesi S.p.A.

Per assistenza contattare: Lucia Piumetto, Tesi S.p.A.
0172 476301 — lucia.piumetto@gruppotesi.com