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Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices

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Title: Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices
Authors: Bajema, IM
Wilhelmus, S
Alpers, CE
Bruijn, JA
Colvin, RB
Cook, HT
D'Agati, VD
Ferrario, F
Haas, M
Jennette, JC
Joh, K
Nast, CC
Noël, L-H
Rijnink, EC
Roberts, ISD
Seshan, SV
Sethi, S
Fogo, AB
Item Type: Journal Article
Abstract: We present a consensus report pertaining to the improved clarity of definitions and classification of glomerular lesions in lupus nephritis that derived from a meeting of 18 members of an international nephropathology working group in Leiden, Netherlands, in 2016. Here we report detailed recommendations on issues for which we can propose adjustments based on existing evidence and current consensus opinion (phase 1). New definitions are provided for mesangial hypercellularity and for cellular, fibrocellular, and fibrous crescents. The term "endocapillary proliferation" is eliminated and the definition of endocapillary hypercellularity considered in some detail. We also eliminate the class IV-S and IV-G subdivisions of class IV lupus nephritis. The active and chronic designations for class III/IV lesions are replaced by a proposal for activity and chronicity indices that should be applied to all classes. In the activity index, we include fibrinoid necrosis as a specific descriptor. We also make recommendations on issues for which there are limited data at present and that can best be addressed in future studies (phase 2). We propose to proceed to these investigations, with clinicopathologic studies and tests of interobserver reproducibility to evaluate the applications of the proposed definitions and to classify lupus nephritis lesions.
Issue Date: 1-Apr-2018
Date of Acceptance: 27-Nov-2017
URI: http://hdl.handle.net/10044/1/57351
DOI: https://dx.doi.org/10.1016/j.kint.2017.11.023
ISSN: 0085-2538
Publisher: Elsevier
Start Page: 789
End Page: 796
Journal / Book Title: Kidney International
Volume: 93
Issue: 4
Copyright Statement: © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
lupus nephritis
renal biopsy
systemic lupus erythematosus
OXFORD CLASSIFICATION
ERYTHEMATOSUS
LESIONS
GLOMERULONEPHRITIS
REPRODUCIBILITY
SYSTEM
1103 Clinical Sciences
Publication Status: Published
Conference Place: United States
Online Publication Date: 2018-02-16
Appears in Collections:Department of Medicine (up to 2019)