Relationship Between The RPS Classification Of Diabetic Nephropathy And Renal Prognosis:A Systematic Review And Meta-analysis

Objective:Using the Research Committee of the Renal Pathology Society(RPS)standard in 2010,to systematically analyze the relationship between pathological classification of diabetic nephropathy(DN)and renal prognosis,so as to provide guidance for clinical use of this classification standard in the future.Methods:We searched MEDLINE,EMBASE,Cochrane Library,CNKI,Wanfang Data and VIP for all studies about the relationship between RPS pathological classification and renal prognosis of DN patients.The retrieval time was from January 2010 to January 2020.Two reviewers selected literature according to the inclusion and exclusion criteria,extracted data and used the Newcastle Ottawa scale(NOS)to evaluate the quality of the selected literature.The meta-analysis was conducted using Stata15.1 software.Results:11 retrospective cohort studies with 1550 patients and 570 end-point renal events were included.In the multivariate analysis model,the HR of overall glomerular class was 1.73(95%CI:1.34,2.24),that of glomerular class 2b was 1.52(95%CI:0.51,4.54),that of glomerular class 3 was 2.44(95%CI:0.85,6.98),and that of glomerular class 4 was 1.80(95%CI:0.40,8.04);HR of Interstitial fibrosis and tubular atrophy(IFTA)was 1.68(95%CI:1.33,2.11);HR of interstitial inflammation was 1.71(95%CI:1.14,2.57);HR of arteriolar hyalinosis was 0.76(95%CI:0.56,1.03);HR of arteriosclerosis was 0.89(95%CI:0.54,1.48).Conclusion:Current evidence suggests that glomerular classification and IFTA may be independent predictors of renal prognosis,interstitial inflammation may be related to renal prognosis,but not vascular lesions.It is suggested that RPS pathological classification has positive significance in predicting renal prognosis in DN patients.Limited by the quantity and quality of the included studies,more high-quality studies are needed to further verify the conclusions of this study.