狼疮性肾炎的病理-刘刚.ppt

狼疮性肾炎的病理改变 北京大学第一医院肾内科 刘刚 重点不在于诊断(但要注意合并其它病变) 分型 活动性和慢性化指标 指导治疗和判断预后 LN的病理分型 自1974年WHO首次公布LN的病理分型标准后，又分别在1982年、1995年及2003年进行了三次重大修订。 2003 ISN/RPS Consensus Conference on the Classification of Lupus Nephritis (preliminary) I: Minimal mesangial lupus glomerulonephritis (LGN) II: Mesangial proliferative LGN III: Focal LGN (involving 50% of glomeruli) A/C IV: Diffuse LGN (involving 50% or glomeruli, IV-S and IV-G) A/C V: Membranous LGN （可以与III或IV重叠） VI: Advanced sclerotic LGN (90% sclerotic glomeruli) 肾脏病理评分 活动指数 慢性指数 肾小球病变 1. 细胞增生 1. 肾小球硬化 2. 纤维素样坏死、核碎裂 2. 纤维性新月体 3. 细胞性新月体 4. 透明血栓，白金耳 5. 炎细胞浸润 肾小管间质病变 1. 单核细胞浸润 1. 间质纤维化 2. 肾小管萎缩 病理报告 狼疮性肾炎IV-G(A/C)＋V 注明特殊病变 新月体、纤维素样坏死等 肾小管、肾间质、血管等 新分型带来的思考 Class IV: IV-S vs. IV-G? Comparison of IV-S and IV-G Studies Our work Renal histopathological data of 327 patients with renal biopsy proven LN Diagnosed between January 2000 and July 2008 in Peking University First Hospital The frequency of serum ANCA was significantly higher in IV-S group than that in IV-G group (20% vs. 4.6%, P=0.008) The frequencies of anti-C1q IgG1 and IgG3 subclass were significantly higher in IV-G group than that in IV-S group (P=0.006, P=0.011, respectively) CrGN was not rare in patients with LN（33/327） ANCA might play a role in crescent formation. 10/33 vs. 3/119 Although aggressive immunosuppressive therapy could achieve clinical remission, their long-term renal outcome was poor. ESRD 7/33 vs. 4/119 5个单位协作 313例，有2年以上随访资料 we found that the 2003 ISN/RPS classification system of lupus nephritis, based on glomerular lesions, could also reflect related tubulointerstitial lesions. 141/313 肾小球病变重、肾间质小管病变轻 15/313 肾小球病变轻、肾间质小管病变重 In multivariate Cox hazard analysis of tubulointerstitial lesions, indices of interstitial infiltration, tubular atrophy, and interstitial fibrosis were confirmed as significant independent risk factors for renal