nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2019-23-4-27-35nefr-1718Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESСтандартизированный подход к классификации и морфологическому описанию гломерулонефритаStandardized classification and reporting of glomerulonephritisСетиС.SethiS.

Отдел внутренних болезней, отделение анатомической патологии, отдел лабораторной медицины и патологии.

Рочестер, Миннесота

Department of Internal Medicine, Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology

Rochester, MN

sethi.sanjeev@mayo.eduФервенцаФ. К.FervenzaF. C.

Отделение нефрологии и гипертензии.

Рочестер, Миннесота

Division of Nephrology and Hypertension

Клиника МэйоСоединённые Штаты АмерикиMayo ClinicUnited States2019210620192342735Copyright © Сети С., Фервенца Ф.К., 20192019Сети С., Фервенца Ф.К.Sethi S., Fervenza F.C.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1718

Выполнение биопсии почки необходимо для определения этиологии гломерулонефрита (ГН), уточнения тяжести ренального повреждения, выявления других повреждений, связанных или нет с ГН на момент нефробиопсии, и, наконец, для уточнения выраженности хронических изменений, произошедших в результате ГН. Этиология ГН определяется исходя из классификации, включающей 5 групп: иммунокомплексный ГН; ГН, ассоциированный с антинейтрофиль-ными цитоплазматическими антителами (АНЦА-ассоциированный); ГН, ассоциированный с антителами к гломерулярной базальной мембране (анти-ГБМ); ГН, опосредованный моноклональными иммуноглобулинами (MIg) и С3-гломерулопатия. Иммунокомплексный ГН включает различные специфические заболевания, такие как люпус-нефрит, IgA-нефропатия, инфекционно-опосредованный ГН и фибриллярный ГН. АНЦА-ассоциированный ГН, анти-ГБМ ГН и С3-гломерулопатия сами по себе являются специфическими заболеваниями, в то время как ГН, опосредованный MIg, включает пролиферативный ГН с депозитами MIg и болезнь отложения MIg. Таким образом, установление класса ГН и конкретной болезни, относящейся к этому классу, определяет этиологию ГН. Для уточнения этиологии ГН могут потребоваться дополнительные исследования. Тяжесть ГН определяется морфологическим паттерном повреждения: ГН с полулуниями, некротизирующий, диффузный пролиферативный, экссудативный, мембранопролиферативный, мезангиопролиферативный или склерозирующий ГН. Также может присутствовать сопутствующий диагноз, как имеющий отношение к ГН, так и нет, например, диабетический гломерулосклероз, острый тубулярный некроз или тромботическая микроангиопатия. Иногда сопутствующее повреждение может быть поводом для биопсии почки. Длительность течения ГН определяется путем оценки степени гломерулосклероза, тубулярной атрофии, интерстициального фиброза и сосудистого склероза в биоптате. В этом обзоре обобщен подход к стандартизации патоморфологического описания нефробиопсии, включающего необходимые этапы в логической и последовательной форме.

Перевод выполнен Д.А. Майером, Т.О. Мужецкой, А.О. Мухаметдиновой, М.С. Храбровой

A kidney biopsy is done to determine the etiology of the glomerulonephritis (GN) and the severity of the lesion, to identify whether other lesions, related to or not related to the GN, are present on the kidney biopsy and finally to ascertain the extent of chronicity of the GN. The etiology of GN is based on the classification of GN into five groups: immune complex-mediated GN, antineutrophil cytoplasmic antibody (ANCA)-associated GN, anti-glomerular basement membrane (GBM) GN, monoclonal immunoglobulin-mediated GN and C3 glomerulopathy. Immune complex GN includes multiple specific diseases such as lupus nephritis, IgA nephropathy, infection-related GN and fibrillary GN. ANCA GN, anti-GBM GN and C3 glomerulopathy are specific diseases in themselves, while monoclonal Ig GN includes proliferative GN with monoclonal Ig deposits and monoclonal Ig deposition disease. Thus identification of the class of GN and within it the specific disease determines the etiology of GN. Ancillary studies may be required to confirm the etiology of GN. The severity of the GN is revealed by the pattern of injury, such as crescentic, necrotizing, diffuse proliferative, exudative, membranoproliferative, mesangial proliferative or a sclerosing GN. Secondary diagnosis either related or unrelated to the GN, such as diabetic glomerulosclerosis, acute tubular necrosis or thrombotic microangiopathy, may also be present. The secondary diagnosis may sometimes be the reason for the kidney biopsy. The chronicity of GN is determined by evaluating the extent of glomerulosclerosis, tubular atrophy and interstitial fibrosis and vascular sclerosis present on the biopsy. This review summarizes the approach to standardizing a kidney biopsy report that includes these components in a logical and sequential manner.

Translation by D.A. Mayer, T.O. Muzhetckaya, A.O. Mukhametdinova, M.S. Khrabrova.

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The authors declare that there are no conflicts of interest present.