A Systematic Review of Interpathologist Agreement in Histologic Classification of Lupus Nephritis

Shobha Dasari, Ashish Chakraborty, Luan Truong, Chandra Mohan

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Introduction: Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE), resulting in increased morbidity and mortality. The gold standard for diagnosis of LN is a renal biopsy. Considering the importance of the biopsy in determining long-term prognostication and treatment decisions, it is crucial to assess renal histopathology with utmost accuracy and precision. This review represents a systematic search of published literature to estimate the degree of interpathologist reproducibility in current assessment of LN. Methods: Using the PubMed and Google Scholar search engines, studies analyzing the agreement of 4 or more pathologists assessing LN slides using the ISN/Renal Pathology Society (RPS) classification, activity index, and chronicity index were selected for analysis in this systematic review. Results: In reviewing 6 qualifying studies (those analyzing the agreement of 4 or more pathologists using the ISN/RPS classification, activity index, and chronicity index) for the assignment of ISN/RPS class was 0.325 (interquartile range [IQR] 0.2405–0.425), which is “poor.” The median interpathologist concordance values for the assigned activity index and chronicity index were “moderate”: 0.52 (IQR 0.51–0.69) and 0.49 (IQR 0.36–0.58), respectively. Conclusion: Thus, the current scoring using the ISN/RPS classification system and activity and chronicity indices for LN exhibits poor interpathologist agreement, which limits its use in clinical practice. Given that this can have severe repercussions on a patient's treatment and prognosis, efforts to update pathology assessment guidelines, objectively measurable biomarkers, and deep learning approaches are strongly warranted.

Original languageEnglish (US)
Pages (from-to)1420-1425
Number of pages6
JournalKidney International Reports
Volume4
Issue number10
DOIs
StatePublished - Oct 2019

Keywords

  • chronic kidney disease
  • glomerulonephritis
  • inflammation
  • kidney biopsy
  • lupus

ASJC Scopus subject areas

  • Ophthalmology
  • Nephrology

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