Abstract
Background: Lupus nephritis affects all renal compartments namely glomeruli, tubules, interstitium and blood vessels. However the ISN/RPS classification of Lupus nephritis depends only on the glomerular changes without any assessment of tubulointerstitial and vascular changes in renal biopsy.
Objectives: 1) To describe the tubulointerstitial and vascular changes in in renal biopsies of six classes of lupus nephritis-ISN/RPS Classification of Lupus nephritis (2004).
2) To describe the immunofluorescent patterns in tubulointerstitium and blood vessels.
Methods:
Study Design: Descriptive study
Study Population: Renal biopsies of clinically and biopsy-proven Lupus nephritis patients irrespective of age and sex which were received in the Department of Pathology, Government medical college, Kottayam during the study period.
Sample Size: 37
Sampling Procedure: Continuous sampling
Results: Tubulointerstitial changes were more prevalent in Class IV cases followed by Class III. Interstitial inflammation was seen in 70% cases, Tubular atrophy in 51% cases, and interstitial fibrosis in 35% cases. Vascular changes were detected in 51% of the study population, more prevalent in Class IV and III cases. Arteriolosclerosis was found in 24% cases, vascular immune deposits in 14% cases, Non-inflammatory necrotizing vasculopathy in 8% cases, and vascular thrombi in 5% cases. Tubular immune complex deposits were observed in 30% cases.
Conclusion: Since the treatment and prognosis are based on the ISN/RPS class of Lupus nephritis, we need a better assessment of each patient by seeing tubulointerstitial and vascular changes also, in addition to glomerular changes.
Keywords: Lupus nephritis, tubulointerstitial changes, vascular changes.
References
- Charles Jennete, Jean L.Oslon et al. Heptinstall’s Pathology of the Kidney 7th edition.2014;1(14):1015-1109.
- M. Bajema, Suzanne Wilhelmus, Charles E.Alpers et al; 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.Kidney Internationale.2018;93(4):789-796
- Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran Pathologic Basis of Disease: South Asian Edition.9th edition,2014; 1:218-225
- Archana C Buch,Sonam K Sood, Sunitha A Bamanikar et al;Role of direct immunofluorescence in the diagnosis of glomerulonephritis Medical Journal of Dr. D.Y Patil Vidyapeeth.2015,8(4):452-7
- C R Ajeethkumar, Lillykutty Pothen, Karthikeyan T.M, Jayakumar K.P. A clinicopathological study of 48 cases of Lupus nephritis.MedPulse International journal of Pathology.2017;3(1):31-35
- Anseena K Muhammed, Lillykutty Pothen, Jayakumar K.P, Sankar S. The role of renal biopsy and IF in classifying nephritic syndrome. Journal of Evolution of medical and Dental Science.2017;6(93):6672-6679
- Nasri H, Mubarak M. Renal vascular lesions in lupus nephritis: A need for further characterization of vasculopathy. Saudi Journal of Kidney Disease and Transplantation. 2015;26(3):604.
- Wu L-H, Yu F, Tan Y, Qu Z, Chen M-H, Wang S-X, et al. Inclusion of renal vascular lesions in the 2003 ISN/RPS system for classifying lupus nephritis improves renal outcome predictions. Kidney Internationale journal. 2013;83(4):715–23.
- Feng Yu, Wu L, Tan Y, Li L, Wang C, Wang W, et al. Tubulointerstitial lesions of patients with lupus nephritis classified by the 2003 International Society of Nephrology and Renal Pathology Society system. Kidney Internationale journal. 2010;77(9):820–9.
- Wu C-Y, Chien H-P, Yang H-Y, Yao T-C, Tseng M-H, Yu M-C, et al. Role of tubulointerstitial lesions in predicting renal outcome among pediatric onset lupus nephritis – A retrospective cohort study. Journal of Microbiology, Immunology and 2020 ;53(1):33–41.
- Nossent J, Berden J, Swaak T. Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis. Lupus Journal. 2000;9:504–10.
- J.M. Mejia-Vilet, B M Cordova-Sanchez,N O Uribe-Uribe et al;Prognostic significance of renal vascular pathology in lupus nephritis, Lupus Journal.2017,26(10):1042-1050
Corresponding Author
Dr Rinku Susan Kurian
Post Graduate Student, Department of Pathology, Govt. Medical College, Kottayam, Kerala, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i11.27
