Clinical Investigation

Kidney International (1986) 29, 1066–1071; doi:10.1038/ki.1986.108

Correlation of renal histology with outcome in children with lupus nephritis

Perry J Rush1, Reuben Baumal1, Abraham Shore1, J Williamson Balfe1 and Martin Schreiber1

1Departments of Paediatrics and Pathology, The Hospital for Sick Children and the Department of Medicine, Sunnybrook Medical Centre, Toronto, Canada

Correspondence: Dr R Baumal, Department of Pathology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8

Received 26 December 1984; Revised 22 March 1985; Re-revised 15 July 1985; Re-revised 21 October 1985.

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Abstract

Correlation of renal histology with outcome in children with lupus nephritis. We assessed renal histological features in 20 children with diffuse proliferative lupus nephritis (DPLN) to determine whether they were useful in predicting clinical outcome. Renal biopsies were analyzed by assigning scores indicating an activity index (AI) and chronicity index (CI). Clinical assessment of renal function at biopsy and outcome were graded according to urinalysis, serum creatinine, need for dialysis and/or transplantation, and/or death from end–stage renal failure. Renal function at biopsy correlated significantly with AI and CI. Serum complement (C3 and C4) correlated significantly with CI but not with AI. The usefulness of the clinical grading system was confirmed in ten patients who underwent repeat biopsies. Of these, four converted from DPLN to mesangial or membranous lupus and showed improvement in their grade, while only one of the six with DPLN on both biopsies improved. After a mean follow–up of 4.0 years, 14 of the 20 patients showed clinical improvement, four were unchanged, and two were worse. CI predicted clinical outcome (P < 0.01) but AI did not. Histologic scores of AI and CI obtained from renal biopsies showing DPLN may be useful in predicting therapeutic responses and designing prospective clinical trials to determine optimum management of children with DPLN.

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References

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