Date: Sunday, November 8, 2015
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
The gold standard for diagnosis and classification of lupus nephritis (LN) is according to the renal histology. The inter-observer reliability between histologists is variable. The aim of this study was to assess the inter-observer reliability of the 2003 International Society of Nephrology/Royal Pathology Society (ISN/RPS) histological classification criteria in children with LN.
Four expert nephropathologists independently reviewed the renal histology slides from children with using electronic software. Diagnostic consistency was quantified using the kappa statistic for nominal categories (Class 1 – 6) and intra-class correlation (ICC) for numeric scores of histological activity (max 24), chronicity (max 12) or tubulointerstitial markers of disease (max 21). The level of agreement (strength of the kappa coefficient or ICC) was interpreted as: 0.01-0.20 slight; 0.21-0.40 fair; 0.41-0.60 moderate; 0.61-0.80 good; 0.81-1.00 excellent. As Class III or IV LN typically result in change of treatment, sub-analysis assessed whether there was agreement between these classes (Class I/II termed ‘no treatment change’, and Class III/IV termed as ‘treatment change’).
The majority of the biopsies (n=55) were graded as Class IV LN (42%) and the median activity score was 4 (0-7), chronicity score 2 (1-3) and tubulointerstitial score 4 (3-6). Nephropathologists showed moderate agreement in assigning LN Classes (kappa score 0.33+0.10; good is >0.6). There was significant variation in the level of agreement between the centres (0.07-0.60). Histological activity had excellent agreement (all ICC >0.75, p<0.001), whereas raters had variable agreement in assigning chronicity and tubulointerstitial scoring (ICC range 0.20-0.82 and -0.13-0.66 respectively). With regards to treatment changes, 14 biopsies would not have resulted in treatment change and 29 may have altered treatment and the level of agreement remained poor (kappa 0.24+0.11).
Internationally agreed classification criteria for LN histology, guide the management of LN. Clinicians and researchers should be aware of the variable level of agreement in their interpretation of LN findings and that is similar in children as it is reported in adults. Histological features of activity have the most consistent agreement. Additional consensus criteria may be necessary to improve the inter-rater variability in the other features.
To cite this abstract in AMA style:Oni L, Beresford M, Witte D, Chatzitolios A, Sebire N, Shukla R, Ying J, Brunner HI. Inter-Observer Variability of the Histological Classification of Lupus Glomerulonephritis in Children [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/inter-observer-variability-of-the-histological-classification-of-lupus-glomerulonephritis-in-children/. Accessed September 28, 2021.
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