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NDT Advance Access originally published online on November 2, 2007
Nephrology Dialysis Transplantation 2008 23(1):223-230; doi:10.1093/ndt/gfm555
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Interobserver agreement of scoring of histopathological characteristics and classification of lupus nephritis

Cecile Grootscholten1, Ingeborg M. Bajema2, Sandrine Florquin3, Eric J. Steenbergen4, Carine J. Peutz-Kootstra5, Roel Goldschmeding6, Marc Bijl7, E. Christiaan Hagen8, Hans C. van Houwelingen9, Ronald H. W. M. Derksen10 and Jo H. M. Berden1

1Division of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, 2Department of Pathology, Leiden University Medical Center, Leiden, 3Department of Pathology, Academic Medical Center, Amsterdam, 4Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, 5Department of Pathology, Academic Hospital Maastricht, Maastricht, 6Department of Pathology, University Medical Center Utrecht, Utrecht, 7Division of Clinical Immunology, University Medical Center Groningen, Groningen, 8Department of Internal Medicine, Meander Medical Center, Amersfoort, 9Department of Medical Statistics, Leiden University Medical Center, Leiden, and 10Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht for the Dutch Working party on SLE

Correspondence to: Jo H.M. Berden, MD, PhD, Division of Nephrology (464), Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Email: j.berden{at}nier.umcn.nl



  Abstract

Background. Assessing renal biopsies from patients with lupus nephritis (LN) is a difficult task and it is subject to interobserver variability. In this study the interobserver agreement amongst five nephropathologists was analysed.

Methods. Five specialized nephropathologists scored 126 biopsies, comprising 87 first and 39 repeat biopsies from 87 patients with biopsy-proven proliferative LN, included in a randomized controlled trial. The interobserver agreement [expressed as intraclass correlation coefficients (ICC)] of the scored histopathological items was calculated. Also, the WHO1995 and ISN/RPS2003 classification systems for LN were compared, with extra attention being given to the comparison between patients with diffuse proliferative LN with either segmental (IV-S) or global (IV-G) lesions.

Results. There was a wide range of agreement. A good interobserver agreement (ICC > 0.6) was present in 15%, and a moderate interobserver agreement (ICC 0.4–0.6) in 31% of the scored items. The activity index for LN showed a good (ICC 0.716) and the chronicity index a moderate (ICC 0.494) interobserver agreement. Both classification systems showed low agreement, although consensus was easily reached. Patients classified as IV-S (n = 15) had more favorable clinical parameters at study entry than those with class IV-G (n = 57). Although suggested by others, we found no differences in outcome between these two subclasses.

Conclusions. This study shows that, although definitions were agreed upon beforehand, even specialized on nephropathologists have difficulties with scoring histopathological characteristics of LN, particularly with SLE the classification systems.

Keywords: agreement; kidney biopsy; lupus nephritis; observer; systemic lupus erythematosus

Received for publication: 24. 6.07
Accepted in revised form: 20. 7.07


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