Lupus classification system too complicated

October 27, 2011

Washington, DC (Thursday, October 27, 2011) -- The current classification system for kidney complications in patients with lupus is too detailed, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results should make it easier for physicians to classify and treat kidney problems in patients with the disease.

People with the autoimmune disease systemic lupus erythematosus (lupus) can experience a number of medical complications, including lupus nephritis, an inflammatory kidney disorder. Lupus nephritis affects approximately 3 out of every 10,000 people, and it can be serious and lead to kidney failure.

Classifying the severity of patients' lupus nephritis can help physicians choose appropriate therapies. The World Health Organization created a classification system that divided cases into six classes based on severity, and in 2003, the International Society of Nephrology and the Renal Pathology Society proposed some revisions. One of the most important changes subdivided class IV (when 50% or more of the kidney is diseased) into a segmental form and a global form depending on exactly how much of the kidney is affected.

This new classification of class IV lupus nephritis resulted from a study of 86 patients that suggested a difference in health outcomes, such as kidney failure, between those with segmental and global forms of the disease.

After the new classification system was published, various studies came to contradictory conclusions about differences in the health outcomes of patients in the two class IV groups. To provide some insight, Jo Berden, MD, PhD, Catharina Haring, MD (Radboud University Nijmegen Medical Center, in Nijmegen, The Netherlands), and their colleagues searched the medical literature and analyzed all of the studies and clinical trials that used the 2003 International Society of Nephrology and Renal Pathology Society classification of lupus nephritis in adult patients.

In the eight studies included in the final analysis, the incidence of kidney failure varied between 0% and 67%. The analysis did not support a significant difference in kidney outcomes between the segmental and global subclasses.

The results suggest the current classification system is too detailed. "This research is important because it could make the categorization of lupus nephritis easier and more comprehensive," said Dr. Berden.
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Study co-authors include Anke Rietveld, MD and Jan van den Brand (Radboud University Nijmegen Medical Center, in Nijmegen, The Netherlands).

Disclosures: The authors reported no financial disclosures.

The article, entitled "Segmental and Global Subclasses of Class IV Lupus Nephritis Have Similar Renal Outcomes," will appear online at http://jasn.asnjournals.org/ on Thursday, October 27, 2011, doi:10.1681/ASN.2011060558.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 12,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

American Society of Nephrology

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