This study is to assess the difference between IV-G and IV-S in a large cohort of Chinese patients with lupus nephritis. The detailed data of patients with subclass IV-G and IV-S were retrospectively analyzed. Serum ANCA and anti-C1q antibodies were detected. A total of 172 cases were classified as class IV, including 152 cases with IV-G and 20 cases with IV-S. In IV-S, the level of haemoglobin was significantly higher (P = 0.024), proteinuria was milder (P = 0.003), serum creatinine was lower (P = 0.021), serum C3 was higher (P = 0.045) and the ratio of positive serum anti-cardiolipin antibodies was higher (P = 0.014). On pathological evaluation, the ratio of glomerular fibrinoid necrosis was significantly higher (P = 0.006) and the score of endocapillary hypercellualrity, interstitial inflammation and total activity indices was significantly lower (P < 0.001, P = 0.01, P = 0.006, respectively) in IV-S. The frequency of serum ANCA was significantly higher in IV-S than that in IV-G (20 vs 4.6%, P = 0.008). The frequencies of anti-C1q IgG1 and IgG3 subclass were significantly higher in IV-G (P = 0.006, P = 0.011, respectively). There are significant differences in clinical and pathological manifestations between IV-S and IV-G lupus nephritis which need further investigation.
2 Appel GB Silva FG Pirani CL . Renal involvement in systemic lupus erythematosus (SLE): a study of 56 patients emphasizing histologic classification. Medicine1978; 75: 371–410.
3.
3 Churg J Sobin L . Renal disease: classification and atlas of glomerular disease.Tokyo: Igaku-Shoin; 1982.
4.
4 Churg J Bernstein J Classock RJ . Renal disease: classification and atlas of glomerular disease.Tokyo: Igaku-Shoin; 1995.
5.
5 Weening JJ D’Agati VD Schwartz MM . The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int2004; 65: 521–530.
6.
6 Najafi CC Korbet SM Lewis EJ . Significance of histologic patterns of glomerular injury upon long-term prognosis in severe lupus glomerulonephritis. Kidney Int2001; 59: 2156–2163.
7.
7 Mittal B Hurwitz S Rennke H Singh AK . New subcategories of class IV lupus nephritis: are there clinical, histologic, and outcome differences? Am J Kidney Dis2004; 44: 1050–1059.
8.
8 Yokoyama H Wada T Hara A . The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese. Kidney Int2004; 66: 2382–2388.
9.
9 Hill GS Delahousse M Nochy D Bariéty J . Class IV-S versus class IV-G lupus nephritis: clinical and morphologic differences suggesting different pathogenesis. Kidney Int2005; 68: 2288–2297.
10.
10 Kim YG Kim HW Cho YM . The difference between lupus nephritis class IV-G and IV-S in Koreans: focus on the response to cyclophosphamide induction treatment. Rheumatology (Oxford)2008; 47: 311–314.
11.
11 Hochberg MC . Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997; 40: 1725.
12.
12 Bombardier C Gladman DD Hocherg M . Validity and reliability of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum1989; 32: 1107–1118.
13.
13 Bombardier C Gladman DD Urowitz MB Caron D Chang CH . The derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum1992; 35: 630–640.
14.
14 Austin HA Muenz LR Joyce KM Antonovych TT Balow JE . Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome. Kidney Int1984; 25: 689–695.
15.
15 Austin HA Boumpas DT Vaughan EM Balow JE . Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data. Kidney Int1994; 45: 544–550.
16.
16 Wang J Hu W Xie H . Induction therapies for class IV lupus nephritis with non-inflammatory necrotizing vasculopathy: mycophenolate mofetil or intravenous cyclophosphamide. Lupus2007; 16: 707–712.
17.
17 Ginzler EM Dooley MA Aranow C . Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med2005; 353: 2219–2228.
18.
18 Chan TM Tse KC Tang CS Lai KN Li FK . Long-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine. Lupus2005; 14: 265–272.
19.
19 Wang HY Cui TG Hou FF . Induction treatment of proliferative lupus nephritis with leflunomide combined with prednisone: a prospective multi-center observational study. Lupus2008; 17: 638–644.
20.
20 Xin G Zhao MH Wang HY . Detection rate and antigenic specificities of antineutrophil cytoplasmic antibodies in Chinese patients with clinically suspected vasculitis. Clin Diagn Lab Immunol2004; 11: 559–562.
21.
21 Fang QY Yu F Tan Y . Anti-C1q antibodies and IgG subclasses distribution in sera from Chinese patients with lupus nephritis. Nephrol Dial Transplant2009; 24: 172–178.
22.
22 Schwartz MM Kawala KS Corwin HL Lewis EJ . The prognosis of segmental glomerulonephritis in systemic lupus erythematosus. Kidney Int1987; 32: 274–279.
23.
23 Korbet SM Lewis EJ Schwartz MM Reichlin M Evans J Rohde RD . Factors predictive of outcome in severe lupus nephritis. Lupus Nephritis Collaborative Study Group. Am J Kidney Dis2000; 35: 904–914.
24.
24 Schwartz MM Roberts JL Lewis EJ . Necrotizing glomerulitis of systemic lupus erythematosus. Hum Pathol1983; 14: 158–167.
25.
25 Sen D Isenberg DA . Antineutrophil cytoplasmic antibodies in systemic lupus erythematosus. Lupus2003; 12: 651–658.
26.
26 Marshall S Dressler R D'Agati V . Membranous lupus nephritis with antineutrophil cytoplasmic antibody-associated segmental necrotizing and crescentic glomerulonephritis. Am J Kidney Dis1997; 29: 119–124.
27.
27 Masani NN Imbriano LJ D'Agati VD Markowitz GS . SLE and rapidly progressive glomerulonephritis. Am J Kidney Dis2005; 45: 950–955.
28.
28 Zhao MH Liu N Zhang YK Wang HY . Antineutrophil cytoplasmic autoantibodies (ANCA) and their target antigens in Chinese patients with lupus nephritis. Nephrol Dial Transplant1998; 13: 2821–2824.
29.
29 Trendelenburg M Margarita LT Eliaka P . High prevalence of anti-C1q antibodies in biopsy-proven active lupus nephritis. Nephrol Dial Transplant2006; 21: 3115–3121.
30.
30 Frémeaux-Bacchi V Noël LH Schifferli JA . No lupus nephritis in the absence of anti-C1q autoantibodies. Nephrol Dial Transplant2002; 17: 2041–2043.
31.
31 Trendelenburg M Marfurt J Gerber I Tyndall A Schifferli JA . Lack of occurrence of severe lupus nephritis among anti-C1q autoantibody-negative patients. Arthritis Rheum1999; 42: 187–188.
32.
32 Trouw LA Seelen MA Duijs JM Benediktsson H Van Kooten C Daha MR . Glomerular deposition of C1q and anti-C1q antibodies in mice following injection of anti-mouse C1q antibodies. Clin Exp Immunol2003; 132: 32–39.
33.
33 Trouw LA Seelen MA Visseren R . Anti-C1q antibodies in murine lupus nephritis. Clin Exp Immunol2004; 135: 41–48.
34.
34 Trouw LA Duijs JM van Kooten C Daha MR . Immune deposition of C1q and anti-C1q antibodies in the kidney is dependent on the presence of glomerular IgG. Mol Immunol2003; 40: 595–602.
35.
35 Trouw LA Groeneveld TW Seelen MA . Anti - C1q auto-antibodies deposit in glomeruli but are only pathogenic in combination with glomerular C1q–containing immune complexes. J Clin Invest2004; 114: 679–688.
