The Classification of Glomerulonephritis in Systemic Lupus Erythematosus Revisited

Abstract

Abstract. The currently used classification reflects our understanding of the pathogenesis of the various forms of lupus nephritis, but clinicopathologic studies have revealed the need for improved categorization and terminology. Based on the 1982 classification published under the auspices of the World Health Organization (WHO) and subsequent clinicopathologic data, we propose that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving Ͻ50% of total number of glomeruli) with subdivisions for active and sclerotic lesions; class IV for diffuse glomerulonephritis (involving Ն50% of total number of glomeruli) either with segmental (class IV-S) or global (class IV-G) involvement, and also with subdivisions for active and sclerotic lesions; class V for membranous lupus nephritis; and class VI for advanced sclerosing lesions]. Combinations of membranous and proliferative glomerulonephritis (i.e., class III and V or class IV and V) should be reported individually in the diagnostic line. The diagnosis should also include entries for any concomitant vascular or tubulointerstitial lesions. One of the main advantages of the current revised classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and lending a basis for further clinicopathologic studies. We hope that this revision, which evolved under the auspices of the International Society of Nephrology and the Renal Pathology Society, will contribute to further advancement of the WHO classification.The morphologic changes in a renal biopsy from a patient with systemic lupus erythematosus (SLE) comprise a spectrum of vascular, glomerular, and tubulointerstitial lesions. The classification of SLE nephritis has evolved over the past 40 years as more lesions were identified and defined. It has been an increasing challenge to apply new pathogenetic insights to the interpretation of the renal biopsy in SLE and to correlate pathologic findings with clinical symptoms, choice of treatment, and prognosis. The current classification, which was advanced in 1982 (1) and revised in 1995 (2), reflects our understanding of the pathogenesis of the various forms of renal injury in SLE nephritis. However, subsequent clinicopathologic studies have revealed the need for clarification of the different categories and the diagnostic terminology. The clas-

Changes of memory B- and T-cell subsets in lupus nephritis patients

“…In particular, we showed a correlation ( Figure 2B, C) between the percentage of immature/early-transitional B-cells and various markers of SLE activity, e.g. SLEDAI According to International Society of Nephrology/Renal Pathology Society criteria [22]. Data are presented as medians [25-75 quartiles].…”

“…SLE was diagnosed based on updated criteria of the American College of Rheumatology [21]. LN was confirmed by renal biopsy and classified according to International Society of Nephrology/Renal Pathology Society (ISN/RPS) criteria [22] as class II (3%), III (15%), IV (56%) or V (8%). In 6 patients (18%) LN was diagnosed based on overt renal symptoms (proteinuria, active urinary sediment) during lupus flare.…”

Immunosuppressive Treatment for Lupus Nephritis: Long-Term Results in 178 Patients

“…Pathology evaluation of LN is crucial: according to the EULAR/ERA-EDTA recommendations for the management of adult and pediatric lupus nephritis [5], immunosuppressive treatment should be guided by renal biopsy findings, assessed according to the International Society of Nephrology/Renal Pathology Society 2003 classification [6]. Initial treatment (IT) recommended for patients with class III-IV (±V) LN includes mycophenolic acid (MPA) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids.…”

Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus

“…Several histologic findings predict those patients whose disease is most likely to progress to renal failure 17 , and this has led to the development of histologic scoring systems. The World Health Organization (WHO) classification system was published in 1982, and was revised by the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) in 2004 21 . The prognostic value of these systems has been validated, and the ISN/RPS system is now widely employed 21, 22 .…”

“…The World Health Organization (WHO) classification system was published in 1982, and was revised by the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) in 2004 21 . The prognostic value of these systems has been validated, and the ISN/RPS system is now widely employed 21, 22 . Several clinical and laboratory findings are also of prognostic importance (such as hypertension, an elevated serum creatinine, and a low serum C3 level) 20 , but a renal biopsy is still considered essential for deciding whether a patient requires treatment 23 .…”