Reliability of histologic scoring for lupus nephritis: A community-based evaluation

Richard M. Wernick, David Smith, Donald Houghton, David S. Phillips, James L. Booth, Douglas N. Runckel, David S. Johnson, Kevin K. Brown, Cynthia L. Gaboury

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Abstract

Objective: To determine the reliability of the National Institutes of Health (NIH)-modified semiquantitative histologic scoring system for lupus nephritis. Design: Cross-sectional study, repeated after 8 to 9 months. Setting: Four community hospitals and one university medical center. Participants: Five pathologists, all experienced in reading renal biopsy specimens, assessed 25 specimens that had been obtained from patients with a clinical diagnosis of systemic lupus erythematosus and showed diffuse proliferative glomerulonephritis. Measurements: Biopsy specimens were scored independently and blindly by pathologists for components of nephritis chronicity and activity. Reliability was measured by percentage agreement, intraclass correlation coefficient or kappa statistic, and individual reader effect on the group arithmetic mean. Results: As scored by the readers, the mean chronicity index score varied from 2.3 to 4.8 on a 12-point scale (P = 0.001) and the mean activity index score varied from 5.8 to 11.4 on a 24- point scale (P = 0.0001). Pairs of readers gave scores within 1 point for the chronicity index and within 2 points for the activity index in 50% of cases, and risk group assignments based on chronicity index (three strata) and activity index (two strata) were concordant in 59% and 76% of cases, respectively. Intraclass correlation coefficients for inter-reader agreement were 0.58 for the chronicity index (P <0.01) and 0.52 for the activity index (P <0.01). Intrareader agreement was uniformly higher than inter-reader agreement, but mean intraclass correlation coefficients exceeded 0.70 for only 1 of the 10 index components. Repeated readings yielded chronicity index scores that were more than 1 point discordant in 45% of cases and activity index scores that were more than 2 points discordant in 43% of cases. Risk group assignment changed on the basis of chronicity index and activity index in 36% and 21% of cases, respectively. Conclusions: In a nonreferral setting, the NIH-modified scoring system for lupus nephritis is only moderately reproducible and, if used to prognosticate renal outcome, may result in erroneous predictions of risk for renal failure and response to therapy.

Original languageEnglish (US)
Pages (from-to)805-811
Number of pages7
JournalAnnals of Internal Medicine
Volume119
Issue number8
StatePublished - Oct 15 1993

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Lupus Nephritis
National Institutes of Health (U.S.)
Reading
Kidney
Biopsy
Nephritis
Community Hospital
Glomerulonephritis
Systemic Lupus Erythematosus
Renal Insufficiency
Cross-Sectional Studies
Pathologists
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wernick, R. M., Smith, D., Houghton, D., Phillips, D. S., Booth, J. L., Runckel, D. N., ... Gaboury, C. L. (1993). Reliability of histologic scoring for lupus nephritis: A community-based evaluation. Annals of Internal Medicine, 119(8), 805-811.

Reliability of histologic scoring for lupus nephritis : A community-based evaluation. / Wernick, Richard M.; Smith, David; Houghton, Donald; Phillips, David S.; Booth, James L.; Runckel, Douglas N.; Johnson, David S.; Brown, Kevin K.; Gaboury, Cynthia L.

In: Annals of Internal Medicine, Vol. 119, No. 8, 15.10.1993, p. 805-811.

Research output: Contribution to journalArticle

Wernick, RM, Smith, D, Houghton, D, Phillips, DS, Booth, JL, Runckel, DN, Johnson, DS, Brown, KK & Gaboury, CL 1993, 'Reliability of histologic scoring for lupus nephritis: A community-based evaluation', Annals of Internal Medicine, vol. 119, no. 8, pp. 805-811.
Wernick, Richard M. ; Smith, David ; Houghton, Donald ; Phillips, David S. ; Booth, James L. ; Runckel, Douglas N. ; Johnson, David S. ; Brown, Kevin K. ; Gaboury, Cynthia L. / Reliability of histologic scoring for lupus nephritis : A community-based evaluation. In: Annals of Internal Medicine. 1993 ; Vol. 119, No. 8. pp. 805-811.
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abstract = "Objective: To determine the reliability of the National Institutes of Health (NIH)-modified semiquantitative histologic scoring system for lupus nephritis. Design: Cross-sectional study, repeated after 8 to 9 months. Setting: Four community hospitals and one university medical center. Participants: Five pathologists, all experienced in reading renal biopsy specimens, assessed 25 specimens that had been obtained from patients with a clinical diagnosis of systemic lupus erythematosus and showed diffuse proliferative glomerulonephritis. Measurements: Biopsy specimens were scored independently and blindly by pathologists for components of nephritis chronicity and activity. Reliability was measured by percentage agreement, intraclass correlation coefficient or kappa statistic, and individual reader effect on the group arithmetic mean. Results: As scored by the readers, the mean chronicity index score varied from 2.3 to 4.8 on a 12-point scale (P = 0.001) and the mean activity index score varied from 5.8 to 11.4 on a 24- point scale (P = 0.0001). Pairs of readers gave scores within 1 point for the chronicity index and within 2 points for the activity index in 50{\%} of cases, and risk group assignments based on chronicity index (three strata) and activity index (two strata) were concordant in 59{\%} and 76{\%} of cases, respectively. Intraclass correlation coefficients for inter-reader agreement were 0.58 for the chronicity index (P <0.01) and 0.52 for the activity index (P <0.01). Intrareader agreement was uniformly higher than inter-reader agreement, but mean intraclass correlation coefficients exceeded 0.70 for only 1 of the 10 index components. Repeated readings yielded chronicity index scores that were more than 1 point discordant in 45{\%} of cases and activity index scores that were more than 2 points discordant in 43{\%} of cases. Risk group assignment changed on the basis of chronicity index and activity index in 36{\%} and 21{\%} of cases, respectively. Conclusions: In a nonreferral setting, the NIH-modified scoring system for lupus nephritis is only moderately reproducible and, if used to prognosticate renal outcome, may result in erroneous predictions of risk for renal failure and response to therapy.",
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T2 - A community-based evaluation

AU - Wernick, Richard M.

AU - Smith, David

AU - Houghton, Donald

AU - Phillips, David S.

AU - Booth, James L.

AU - Runckel, Douglas N.

AU - Johnson, David S.

AU - Brown, Kevin K.

AU - Gaboury, Cynthia L.

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Y1 - 1993/10/15

N2 - Objective: To determine the reliability of the National Institutes of Health (NIH)-modified semiquantitative histologic scoring system for lupus nephritis. Design: Cross-sectional study, repeated after 8 to 9 months. Setting: Four community hospitals and one university medical center. Participants: Five pathologists, all experienced in reading renal biopsy specimens, assessed 25 specimens that had been obtained from patients with a clinical diagnosis of systemic lupus erythematosus and showed diffuse proliferative glomerulonephritis. Measurements: Biopsy specimens were scored independently and blindly by pathologists for components of nephritis chronicity and activity. Reliability was measured by percentage agreement, intraclass correlation coefficient or kappa statistic, and individual reader effect on the group arithmetic mean. Results: As scored by the readers, the mean chronicity index score varied from 2.3 to 4.8 on a 12-point scale (P = 0.001) and the mean activity index score varied from 5.8 to 11.4 on a 24- point scale (P = 0.0001). Pairs of readers gave scores within 1 point for the chronicity index and within 2 points for the activity index in 50% of cases, and risk group assignments based on chronicity index (three strata) and activity index (two strata) were concordant in 59% and 76% of cases, respectively. Intraclass correlation coefficients for inter-reader agreement were 0.58 for the chronicity index (P <0.01) and 0.52 for the activity index (P <0.01). Intrareader agreement was uniformly higher than inter-reader agreement, but mean intraclass correlation coefficients exceeded 0.70 for only 1 of the 10 index components. Repeated readings yielded chronicity index scores that were more than 1 point discordant in 45% of cases and activity index scores that were more than 2 points discordant in 43% of cases. Risk group assignment changed on the basis of chronicity index and activity index in 36% and 21% of cases, respectively. Conclusions: In a nonreferral setting, the NIH-modified scoring system for lupus nephritis is only moderately reproducible and, if used to prognosticate renal outcome, may result in erroneous predictions of risk for renal failure and response to therapy.

AB - Objective: To determine the reliability of the National Institutes of Health (NIH)-modified semiquantitative histologic scoring system for lupus nephritis. Design: Cross-sectional study, repeated after 8 to 9 months. Setting: Four community hospitals and one university medical center. Participants: Five pathologists, all experienced in reading renal biopsy specimens, assessed 25 specimens that had been obtained from patients with a clinical diagnosis of systemic lupus erythematosus and showed diffuse proliferative glomerulonephritis. Measurements: Biopsy specimens were scored independently and blindly by pathologists for components of nephritis chronicity and activity. Reliability was measured by percentage agreement, intraclass correlation coefficient or kappa statistic, and individual reader effect on the group arithmetic mean. Results: As scored by the readers, the mean chronicity index score varied from 2.3 to 4.8 on a 12-point scale (P = 0.001) and the mean activity index score varied from 5.8 to 11.4 on a 24- point scale (P = 0.0001). Pairs of readers gave scores within 1 point for the chronicity index and within 2 points for the activity index in 50% of cases, and risk group assignments based on chronicity index (three strata) and activity index (two strata) were concordant in 59% and 76% of cases, respectively. Intraclass correlation coefficients for inter-reader agreement were 0.58 for the chronicity index (P <0.01) and 0.52 for the activity index (P <0.01). Intrareader agreement was uniformly higher than inter-reader agreement, but mean intraclass correlation coefficients exceeded 0.70 for only 1 of the 10 index components. Repeated readings yielded chronicity index scores that were more than 1 point discordant in 45% of cases and activity index scores that were more than 2 points discordant in 43% of cases. Risk group assignment changed on the basis of chronicity index and activity index in 36% and 21% of cases, respectively. Conclusions: In a nonreferral setting, the NIH-modified scoring system for lupus nephritis is only moderately reproducible and, if used to prognosticate renal outcome, may result in erroneous predictions of risk for renal failure and response to therapy.

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