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Clin J Am Soc Nephrol. 2019 Nov 7;14(11):1605-1615. doi: 10.2215/CJN.01570219. Epub 2019 Oct 25.

Sensitivity and Specificity of Pathologic Findings to Diagnose Lupus Nephritis.

Author information

1
Department of Pathology and Cell Biology and.
2
Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
3
Department of Pathology and Cell Biology and gsm17@cumc.columbia.edu.

Abstract

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.

KEYWORDS:

Fluorescent Antibody Technique; Staining and Labeling; biopsy; control groups; glomerulonephritis; glomerulonephritis, IGA; glomerulonephritis, Membranoproliferative; glomerulonephritis, Membranous; humans; kidney; kidney biopsy; lupus nephritis; pathology; systemic lupus erythematosus

PMID:
31653670
PMCID:
PMC6832038
[Available on 2020-11-07]
DOI:
10.2215/CJN.01570219

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