BACKGROUND AND OBJECTIVES: In 2012, the Systemic Lupus International Collaborating Clinics proposed that lupus nephritis, in the presence of positive ANA or anti-dsDNA antibody, is sufficient to diagnose SLE. However, this "stand-alone" kidney biopsy criterion is problematic because the ISN/RPS classification does not specifically define lupus nephritis. We investigated the combination of pathologic features with optimal sensitivity and specificity for the diagnosis of lupus nephritis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Three hundred consecutive biopsies with lupus nephritis and 560 contemporaneous biopsies with nonlupus glomerulopathies were compared. Lupus nephritis was diagnosed if there was a clinical diagnosis of SLE and kidney biopsy revealed findings compatible with lupus nephritis. The control group consisted of consecutives biopsies showing diverse glomerulopathies from patients without SLE, including IgA nephropathy, membranous glomerulopathy, pauci-immune glomerulonephritis, membranoproliferative glomerulonephritis (excluding C3 GN), and infection-related glomerulonephritis. Sensitivity and specificity of individual pathologic features and combinations of features were computed. RESULTS: Five characteristic features of lupus nephritis were identified: "full-house" staining by immunofluorescence, intense C1q staining, extraglomerular deposits, combined subendothelial and subepithelial deposits, and endothelial tubuloreticular inclusions, each with sensitivity ranging from 0.68 to 0.80 and specificity from 0.8 to 0.96. The presence of at least two, three, or four of the five criteria had a sensitivity of 0.92, 0.8, and 0.66 for the diagnosis of lupus nephritis, and a specificity of 0.89, 0.95, and 0.98. CONCLUSIONS: In conclusion, combinations of pathologic features can distinguish lupus nephritis from nonlupus glomerulopathies with high specificity and varying sensitivity. Even with stringent criteria, however, rare examples of nonlupus glomerulopathies may exhibit characteristic features of lupus nephritis.
BACKGROUND AND OBJECTIVES: In 2012, the Systemic Lupus International Collaborating Clinics proposed that lupus nephritis, in the presence of positive ANA or anti-dsDNA antibody, is sufficient to diagnose SLE. However, this "stand-alone" kidney biopsy criterion is problematic because the ISN/RPS classification does not specifically define lupus nephritis. We investigated the combination of pathologic features with optimal sensitivity and specificity for the diagnosis of lupus nephritis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Three hundred consecutive biopsies with lupus nephritis and 560 contemporaneous biopsies with nonlupus glomerulopathies were compared. Lupus nephritis was diagnosed if there was a clinical diagnosis of SLE and kidney biopsy revealed findings compatible with lupus nephritis. The control group consisted of consecutives biopsies showing diverse glomerulopathies from patients without SLE, including IgA nephropathy, membranous glomerulopathy, pauci-immune glomerulonephritis, membranoproliferative glomerulonephritis (excluding C3 GN), and infection-related glomerulonephritis. Sensitivity and specificity of individual pathologic features and combinations of features were computed. RESULTS: Five characteristic features of lupus nephritis were identified: "full-house" staining by immunofluorescence, intense C1q staining, extraglomerular deposits, combined subendothelial and subepithelial deposits, and endothelial tubuloreticular inclusions, each with sensitivity ranging from 0.68 to 0.80 and specificity from 0.8 to 0.96. The presence of at least two, three, or four of the five criteria had a sensitivity of 0.92, 0.8, and 0.66 for the diagnosis of lupus nephritis, and a specificity of 0.89, 0.95, and 0.98. CONCLUSIONS: In conclusion, combinations of pathologic features can distinguish lupus nephritis from nonlupus glomerulopathies with high specificity and varying sensitivity. Even with stringent criteria, however, rare examples of nonlupus glomerulopathies may exhibit characteristic features of lupus nephritis.
Authors: Ana Huerta; Andrew S Bomback; Vassilis Liakopoulos; Amudha Palanisamy; M Barry Stokes; Vivette D D'Agati; Jai Radhakrishnan; Glen S Markowitz; Gerald B Appel Journal: Nephrol Dial Transplant Date: 2011-12-29 Impact factor: 5.992
Authors: Emilie C Rijnink; Y K Onno Teng; Tineke Kraaij; Olaf M Dekkers; Jan A Bruijn; Ingeborg M Bajema Journal: Kidney Int Date: 2017-09-23 Impact factor: 10.612
Authors: Emilie C Rijnink; Y K Onno Teng; Tineke Kraaij; Ron Wolterbeek; Jan A Bruijn; Ingeborg M Bajema Journal: Nephrol Dial Transplant Date: 2017-04-01 Impact factor: 5.992
Authors: Michelle Petri; Ana-Maria Orbai; Graciela S Alarcón; Caroline Gordon; Joan T Merrill; Paul R Fortin; Ian N Bruce; David Isenberg; Daniel J Wallace; Ola Nived; Gunnar Sturfelt; Rosalind Ramsey-Goldman; Sang-Cheol Bae; John G Hanly; Jorge Sánchez-Guerrero; Ann Clarke; Cynthia Aranow; Susan Manzi; Murray Urowitz; Dafna Gladman; Kenneth Kalunian; Melissa Costner; Victoria P Werth; Asad Zoma; Sasha Bernatsky; Guillermo Ruiz-Irastorza; Munther A Khamashta; Soren Jacobsen; Jill P Buyon; Peter Maddison; Mary Anne Dooley; Ronald F van Vollenhoven; Ellen Ginzler; Thomas Stoll; Christine Peschken; Joseph L Jorizzo; Jeffrey P Callen; S Sam Lim; Barri J Fessler; Murat Inanc; Diane L Kamen; Anisur Rahman; Kristjan Steinsson; Andrew G Franks; Lisa Sigler; Suhail Hameed; Hong Fang; Ngoc Pham; Robin Brey; Michael H Weisman; Gerald McGwin; Laurence S Magder Journal: Arthritis Rheum Date: 2012-08
Authors: Ingeborg M Bajema; Suzanne Wilhelmus; Charles E Alpers; Jan A Bruijn; Robert B Colvin; H Terence Cook; Vivette D D'Agati; Franco Ferrario; Mark Haas; J Charles Jennette; Kensuke Joh; Cynthia C Nast; Laure-Hélène Noël; Emilie C Rijnink; Ian S D Roberts; Surya V Seshan; Sanjeev Sethi; Agnes B Fogo Journal: Kidney Int Date: 2018-02-16 Impact factor: 10.612
Authors: Jan J Weening; Vivette D D'Agati; Melvin M Schwartz; Surya V Seshan; Charles E Alpers; Gerald B Appel; James E Balow; Jan A Bruijn; Terence Cook; Franco Ferrario; Agnes B Fogo; Ellen M Ginzler; Lee Hebert; Gary Hill; Prue Hill; J Charles Jennette; Norella C Kong; Philippe Lesavre; Michael Lockshin; Lai-Meng Looi; Hirofumi Makino; Luiz A Moura; Michio Nagata Journal: J Am Soc Nephrol Date: 2004-02 Impact factor: 10.121
Authors: Meghan E Sise; Jessica Wisocky; Ivy A Rosales; Donald Chute; Jacinta A Holmes; Kristin M Corapi; Jodie L Babitt; Jessica S Tangren; Nikroo Hashemi; Andrew L Lundquist; Winfred W Williams; David B Mount; Karin L Andersson; Helmut G Rennke; R Neal Smith; Robert Colvin; Ravi I Thadhani; Raymond T Chung Journal: Kidney Int Rep Date: 2016-09
Authors: Carlos Mauricio Martínez Montalvo; Laura Catalina Gutierrez; Carolina Perez; Harrison Herrera Delgado; Paula Corinna Martinez Barrios Journal: J Bras Nefrol Date: 2022 Apr-Jun
Authors: Teresa K Chen; Michelle M Estrella; Lawrence J Appel; Josef Coresh; Shengyuan Luo; Jochen Reiser; Wassim Obeid; Chirag R Parikh; Morgan E Grams Journal: Am J Kidney Dis Date: 2021-01-01 Impact factor: 11.072