The International Society of Nephrology (ISN) and Renal Pathology Society (RPS) developed a classification scheme for histologic features of lupus nephritis.
Histologic Type of Lupus Nephritis
subepithelial with or without subendothelial
If < 50% of glomeruli are involved, it is focal. If >= 50% of glomeruli it is diffuse.
If < 50% of a glomerulus is involved, it is segmental. If >= 50% of a glomerulus is involved it is global.
Percent of Glomerulus Affected
Percent of Glomeruli Affected < 50%
Percent of Glomeruli Affected >= 50%
Features of minimal mesangial (Class I):
(1) normal on light microscopy
(2) mesangial deposits seen on immunofluorescence (IF)
Features of mesangial proliferation (Class II):
(1) mesangial hypercellularity and/or matrix expansion
(2) mesangial deposits on immunofluorescence (IF)
(3) may show rare subepithelial or subendothelial deposits on IF or electron microscopy (EM)
Features of focal (Class III):
(1) < 50% of glomeruli affected
(2) subendothelial immune deposits
(3a) active (A)
(3b) chronic inactive with scarring (C)
(3c) both active and chronic (A/C)
Features of diffuse (Class IV):
(1) >= 50% of glomeruli affected
(3a) segmental active: S(A)
(3b) global active: G(A)
(3c) segmental chronic inactive with scarring: S(C)
(3d) global chronic inactive with scarring: G(C)
(3e) segmental with both active and chronic: S(A/C)
(3f) global with both active and chronic: G(A/C)
Features of membranous (Class V):
(1) segmental or global subepithelial immune deposits
(2) may show Class III or IV changes
Features of advanced sclerosing (Class VI):
(1) >= 90% of glomeruli are globally sclerosed and inactive
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Purpose: To evaluate a renal biopsy from a patient with SLE using the classification of the International Society of Pathology and Renal Pathology Society.
Specialty: Nephrology, Clinical Laboratory, Immunology/Rheumatology
Objective: clinical diagnosis, including family history for genetics, severity, prognosis, stage
ICD-10: M32.1, N08,