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Table 2 Scoring methods for the histological evaluation of kidney biopsies

From: Kidney histopathology in lethal human sepsis

Compartment
 Histological feature
  • Scoring method
Glomerulus
 Total count glomeruli
  • All representative (adequately cross-cut) glomeruli together of 27 patients with sepsis
 Sclerotic glomeruli
  • Scored positive when total sclerosis of glomerulus is observed
 Glomerulitis
  • Yes: ≥ 10 leukocytes in glomerular capillaries
  • No: < 10 leukocytes in glomerular capillaries
 Increase in mesangial matrix
  • Stage 0: no mesangial matrix increase
  • Stage 1: up to 25% of non-sclerotic glomeruli affected (at least moderate matrix increase)
  • Stage 2: 26–50% of non-sclerotic glomeruli affected (at least moderate matrix increase)
  • Stage 3: > 50% of non-sclerotic glomeruli affected (at least moderate matrix increase)
 Leukocyte subsets
  • Number of CD3, CD20, CD68 and neutrophil elastase-positive cells in glomeruli divided by the total count of glomeruli, reported as mean number of positive cells/glomerulus
 Proliferating cells
  • Number of Ki-67 positive cells/glomerulus
 Myofibroblasts
  • Number of anti-α-SMA positive cells in glomeruli divided by the total count of glomeruli, reported as mean positive foci/glomerulus
 Thrombus formation
  • Martius, scarlet and blue positive cells in glomeruli divided by the total count of glomeruli, reported as mean positive foci/glomerulus
Apoptosis
  • Number of Anti-caspase-3 positive cells in glomeruli divided by the total count of glomeruli, reported as mean positive foci/glomerulus
Tubulointerstitium
 Tubulitis
  • Stage 0: no mononuclear cells in tubules
  • Stage 1: 1–4 mononuclear cells/tubular cross-section
  • Stage 2: 5–10 mononuclear cells/tubular cross-section
  • Stage 3: > 10 mononuclear cells/tubular cross-section
 Interstitial inflammation
  • Stage 0: no or hardly any interstitial parenchyma covered with mononuclear cells
  • Stage 1: 10–25% of interstitial parenchyma covered with mononuclear cells
  • Stage 2: 26–50% of interstitial parenchyma covered with mononuclear cells
  • Stage 3: > 50% of interstitial parenchyma covered with mononuclear cells
 Interstitial fibrosis
  • Stage 0: interstitial fibrosis tissue of up to 5% of total area
  • Stage 1: mild-interstitial fibrosis tissue of 6–25% of total area
  • Stage 2: moderate-interstitial fibrosis of 26–50% of total area
  • Stage 3: severe interstitial fibrosis of > 50% of total area
 Tubular atrophy
  • Stage 0: no tubular atrophy
  • Stage 1: atrophy in 0–25% of the tubules
  • Stage 2: atrophy in 26–50% of the tubules
  • Stage 3: atrophy of > 50% of the tubules
Leukocyte subsets
 Number of CD3, CD20, CD68 and neutrophil elastase-positive cells
  • Stage 0: absent
  • Stage 1: focally present
  • Stage 2: diffusely present
 Proliferating cells
  • Number of Ki-67 positive cells/200 tubular epithelial cells
Myofibroblasts
 anti-α-SMA positive cells present in tubulointerstitium
  • Stage 0: none
  • Stage 1: present in 0–25% of tubulointerstitium
  • Stage 2: present in 26–50% of tubulointerstitium
  • Stage 3: present in 51–75% of tubulointerstitium
  • Stage 4: present in > 75% of tubulointerstitium
 Thrombus formation
  • Number of martius, scarlet and blue total positive foci/2 mm2
Apoptosis
 Number of Anti-caspase-3 total positive cells present in tubulointerstitium
  • Stage 0: absent
  • Stage 1: present in 0–10% of total interstitial cells
  • Stage 2: present in 11–50% of total interstitial cells
  • Stage 3: present in > 50% of total interstitial cells
Blood vessels
 Arteriolar intima sclerosis
  • Stage 0: no chronic vascular changes
  • Stage 1: vascular narrowing of up to 25% luminal area of arteries fibro-intimal thickening
  • Stage 2: vascular narrowing with 26–50% luminal area of arteries fibro-intimal thickening
  • Stage 3: vascular narrowing with 26–50% luminal area of arteries fibro-intimal thickening
 Arteriolar hyaline
  • Stage 0: no PAS-positive hyaline thickening
  • Stage 1: mild-to-moderate PAS-positive hyaline in at least one arteriole
  • Stage 2: moderate-to-severe PAS-positive hyaline thickening in more than one arteriole
  • Stage 3: severe PAS-positive hyaline thickening in many arterioles
 Intima arteritis
  • Stage 0: no arteritis
  • Stage 1: mild-to-moderate intimal arteritis in at least one arterial cross-section
  • Stage 2: severe intima arteritis with at least 25% luminal area lost in at least one arterial cross-section
  • Stage 3: arterial fibrinoid change and/or transmural arteritis with medial smooth muscle necrosis with lymphocytic inflammation
 Peritubular capillaritis
  • Stage 0: < 10% of capillaries contain inflammatory cells
  • Stage 1: > 10% of capillaries contain inflammatory cells, 3–4 mononuclear cells in peritubular capillary lumen
  • Stage 2: > 10% of capillaries contain inflammatory cells, 5–10 mononuclear cells in peritubular capillary lumen
  • Stage 3: if > 10% of capillaries contain inflammatory cells, > 10 mononuclear cells in peritubular capillary lumen
  1. PAS periodic acid–Schiff, SMA smooth muscle actin