Lupus nephritis (LN) is a life-threatening complication of systemic lupus erythematosus. The 2003 pathological classification of LN was revised in 2016; it quantitatively evaluates the interstitium in addition to the glomeruli. We performed a retrospective multi-centre cohort study and investigated the utility of the 2016 classification—including the activity index (AI), chronicity index (CI), and each pathological component to predict complete remission or renal function decline, defined as 1.5-fold increase in serum creatinine levels—and compare with that of the 2003 classification. Ninety-one consecutive adult patients with first-onset class III/IV LN who were newly prescribed any immunosuppressants were enrolled and followed up for a median of 51 months from January 2004. Cox regression analysis demonstrated the subclasses based on the 2003 classification, which mainly evaluate glomerular lesions, were not associated with clinical outcomes. After adjustments for estimated glomerular filtration rate and urinary protein levels, higher CI and higher interstitial fibrosis and lower hyaline deposit scores were associated with renal functional decline. Similarly, higher CI and interstitial inflammation scores were associated with failure to achieve complete remission. Therefore, the 2016 classification can predict the clinical outcomes more precisely than the 2003 classification.

狼疮性肾炎 (LN) 是系统性红斑狼疮的危及生命的并发症。2003年LN病理分型于2016年修订；除了肾小球外，它还定量评估间质。我们进行了一项回顾性多中心队列研究，并研究了 2016 年分类的效用——包括活动指数 (AI)、慢性指数 (CI) 和预测完全缓解或肾功能下降的每个病理成分，定义为 1.5 倍血清肌酐水平的增加——并与 2003 年的分类进行比较。从 2004 年 1 月起，连续招募了 91 名新开具任何免疫抑制剂处方的首次发作的 III/IV 级 LN 成人患者，并进行了中位随访 51 个月。Cox 回归分析表明，基于 2003 年分类的亚类主要评估肾小球病变，与临床结果无关。在对估计的肾小球滤过率和尿蛋白水平进行调整后，较高的 CI 和较高的间质纤维化以及较低的透明沉积评分与肾功能下降有关。同样，较高的 CI 和间质炎症评分与未能达到完全缓解有关。因此，2016 年的分类可以比 2003 年的分类更准确地预测临床结果。较高的 CI 和较高的间质纤维化以及较低的透明沉积评分与肾功能下降有关。同样，较高的 CI 和间质炎症评分与未能达到完全缓解有关。因此，2016 年的分类可以比 2003 年的分类更准确地预测临床结果。较高的 CI 和较高的间质纤维化以及较低的透明沉积评分与肾功能下降有关。同样，较高的 CI 和间质炎症评分与未能达到完全缓解有关。因此，2016 年的分类可以比 2003 年的分类更准确地预测临床结果。