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ループス腎炎の組織学的分類(ISN/RPS分類、2004年)
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SLEでは約80%に腎病変が認められ、そのうち25~30%が難治性で、10%程度が腎不全に移行する。ループス腎炎の組織学的分類は予後と治療反応性を反映し、治療方針決定に重要である。ループス腎炎の組織学的分類は2004年に国際腎臓病学会(ISN)と国際病理学会(RPS)により改訂された。IV型が最も腎不全に移行しやすく、III型もそれに次いで予後が悪い。慢性病変(C)があるとステロイドによる治療の効果が期待できない。

出典

img 1:  The classification of glomerulonephritis in systemic lupus erythematosus revisited.
 
著者: 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
雑誌名: J Am Soc Nephrol. 2004 Feb;15(2):241-50.
Abstract/Text The currently used classification reflects our understanding of the pathogenesis of the various forms of lupus nephritis, but clinicopathologic studies have revealed the need for improved categorization and terminology. Based on the 1982 classification published under the auspices of the World Health Organization (WHO) and subsequent clinicopathologic data, we propose that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving <50% of total number of glomeruli) with subdivisions for active and sclerotic lesions; class IV for diffuse glomerulonephritis (involving > or = 50% of total number of glomeruli) either with segmental (class IV-S) or global (class IV-G) involvement, and also with subdivisions for active and sclerotic lesions; class V for membranous lupus nephritis; and class VI for advanced sclerosing lesions]. Combinations of membranous and proliferative glomerulonephritis (i.e., class III and V or class IV and V) should be reported individually in the diagnostic line. The diagnosis should also include entries for any concomitant vascular or tubulointerstitial lesions. One of the main advantages of the current revised classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and lending a basis for further clinicopathologic studies. We hope that this revision, which evolved under the auspices of the International Society of Nephrology and the Renal Pathology Society, will contribute to further advancement of the WHO classification.

  J Am Soc Nephrol. 2004 Feb;15(2):241-50.・・・