Suzuki and Joh reported a histologic scoring system to describe pathologic changes in patients with IgA nephropathy. The authors are from Sakura National Hospital in Chiba, Japan.
Parameters for activity index (AI)
(1) percent of glomeruli showing mesangial hypercellularity
(2) percent of glomeruli showing active intercapillary glomerular lesions (macrophage infiltration, mesangiolysis)
(3) percent of glomeruli showing active extracapillary glomerular lesions (cellular crescents, fibrocellular crescents, tuft necrosus)
(4) extent of tubulointerstitial inflammatory lesions in non-scarred areas of the cortex
Parameters for chronicity index (CI):
(1) percent glomeruli showing global sclerosis
(2) percent of glomeruli showing chronic intercapillary glomerular lesions (segmental sclerosis, segmental hyalinosis, periglomerular fibrosis, collapsed glomeruli)
(3) percent of glomeruli showing chronic extracapillary glomerular lesions (fibrous crescents, tuft adhesions)
(4) extent of interstitial fibrosis
|
Parameter |
Finding |
Points |
|
mesangial hypercellularity |
0% |
0 |
|
|
1 to 39% |
1 |
|
|
40 to 79% |
2 |
|
|
80 to 100% |
3 |
|
active intercapillary lesions |
0% |
0 |
|
|
1 to 49% |
1 |
|
|
50 to 100% |
2 |
|
active extracapillary lesions |
0% |
0 |
|
|
1 to 29% |
2 |
|
|
30 to 100% |
4 |
|
tubulointerstitial inflammation |
0% |
0 |
|
|
1 to 29% |
1 |
|
|
30 to 100% |
2 |
|
global sclerosis |
0 to 9% |
0 |
|
|
10 to 29% |
1 |
|
|
30 to 49% |
2 |
|
|
50 to 100% |
3 |
|
chronic intercapillary lesions |
0 to 9% |
0 |
|
|
10 to 29% |
1 |
|
|
30 to 49% |
2 |
|
|
50 to 100% |
3 |
|
chronic extracapillary lesions |
0 to 9% |
0 |
|
|
10 to 29% |
1 |
|
|
30 to 49% |
2 |
|
|
50 to 100% |
3 |
|
interstitial fibrosis |
0 to 9% |
0 |
|
|
10 to 29% |
1 |
|
|
30 to 49% |
2 |
|
|
50 to 100% |
3 |
total activity index =
= SUM(points for all 4 active parameters)
total chronicity index =
= SUM(points for all chronic parameters)
Interpretation:
• minimum active or chronic index: 0
• maximum active index: 11
• maximum chronic index: 12
• The higher the indices the more serious the disease.
Specialty: Nephrology, Clinical Laboratory, Immunology/Rheumatology
