Diffuse proliferative lupus nephritis: Identification of specific patholog-ic features affecting renal outcome. Prerandomization renal biopsy specimens were examined in 102 patients upon entry into prospective therapeutic trials of lupus nephntis in an attempt to identify early predictors of renal failure outcome. All 11 renal failures occurred among the 72 individuals with diffuse proliferative or membranoproliferative glomerulonephritis (DPGN/MPGN); thus, these patients were at modestly, but significantly, increased risk of endstage renal disease compared to those with focal proliferative, membranous, or mesangial glomerulonephritis. Considering the low incidence of endstage renal disease among patients with DPGN/MPGN, we sought to refine the prognostic information obtained from renal morphology by semiquanti-tative scoring of individual histologic features and by derivation of composite histologic scores specified by Activity (Al) and Chronicity (CI) Indices. Among the 72 patients with DPGN/MPGN, the composite AL was more strongly predictive of renal failure than were the individual active histologic features; cellular crescents and extensive fibrinoid necrosis yielded positive associations, while endocapillary prolifera-tion, leucocytic exudation, and hyaline thrombi in glomeruli and interstitial inflammation by themselves did not emerge as useful prog-nostic indicators. However, chronicity items (glomerular sclerosis, fibrous crescents, tubular atrophy, and interstitial fibrosis) considered individually, as well as in the composite CI, were highly predictive of renal failure outcome. Particularly striking was the prognostic value of tubular atrophy; all 11 renal failures were among the 43 patients with tubular atrophy on prerandomization renal biopsy. While no single pathologic variable improved outcome predictions among those with tubular atrophy, examination for interactions among variables revealed that glomerular sclerosis and cellular crescents had a synergistic effect which augmented the prognostic information derived from analysis of tubular atrophy alone. Thus, the simultaneous occurrence of tubular atrophy, glomerular sclerosis, and cellular crescents identified a very high-risk group; six of nine patients progressed to endstage renal disease within 4 years of study entry. In conclusion, semiquantitative scoring of individual histologic features can refine estimates of the risk of renal failure in lupus patients with DPGN or MPGN.

Néphrite lupique proliferative diffuse: Identification de caracteristiques pathologiques spécifiques affectant l'évolution rénale. Les specimens biopsies rénales de 102 malades avant randomisation ont été examinées a l'entrée dans des essais therapeutiques prospectifs de Ia néphrite lupique, destinés a identifier les facteurs prédictifs precoces de survenue d'une insuffisance rénale. La totalité des 11 insuffisances rénales est survenue parmi les 72 sujets atteints d'une glomérulonephrite diffuse proliferative ou membrano-proliferative (DPGN/MPGN); ainsi, ces malades avaient un risque modérément, mais significativement, accru de nephropathie terminale, par rapport a ceux atteints d'une glomérulonéphnte proliferative focale, extramembraneuse ou mesangiale. En considérant Ia faible incidence d'une néphropathie terminale parmi les patients atteints de DPGN/MPGN, nous avons cherchC a affiner l'information pronostique obtenue a partir de Ia morphologie rénale par un