Is The Histological Scoring System Useful In Assessing Patients With Glomerulonephritis?

Glomerular and tubulo-interstitial lesions are involved in the determination of the degree of renal function impairment and in the outcome of the disease in patients with primary or secondary glomerulonephritis. In order to assess the histological changes we used a scoring system, similar to the one used in lupus nephritis and ANCA associated vasculitis. The scores obtained from the retrospective evaluation of the renal biopsies of 41 patients with primary and secondary glomerulonephritis were correlated to serum creatinine (SC) and glomerular filtration rate (GFR). We observed a correlation between interstitial scores for activity with renal function: interstitial edema with SC (R= 0.42, P=0.002) and GFR(R= -0.41, P=0.003); interstitial infiltrate with SC(R=0.55, P<0.0001) and GFR(R= -0.62, P<0.0001); total activity index with SC (R=0.54, P=0.0001) and GFR (R= -0.49, P=0.003). We also found significant correlation of renal function tests with tubulo-interstitial scores of chronicity: interstitial fibrosis with SC (R=0.49, P=0.0006) and GFR (R= -0.59, P<0.0001); tubular atrophies with SC (R=0.41, P=0.003) and GFR(R= -0.59, P<0.0001); vascular hyalinosis/fibrosis with SC (R=0.42,P=0.002) and GFR (R= -0.59, P<0.0001); total chronicity index with SC (R=0.50, P=0.0003) and GFR (R= -0.65,P<0.0001). We also observed a correlation between the glomerular segmental sclerosis score and SC (R= 0.3, P=0.02) and GFR (R= -0.42, P=0.003). A scoring system of histological changes is important in the assessment of active and chronic glomerular changes in patients with different primary or secondary glomerulonephritis.