The World Health Organization (WHO) developed a morphologic classification for lupus nephritis.
Parameters:
(1) mesangial changes
(2) membranous change
(3) deposits on immunofluorescence (IF) and/or electron microscopy (EM)
(4) lesions
(5) sclerosis
(6) active lesions
Classes:
(I) normal glomeruli
(II) pure mesangial alterations
(III) focal segmental glomerulonephritis
(IV) diffuse glomerulonephritis
(V) diffuse membranous glomerulonephritis
(VI) advanced sclerosing glomerulonephritis
|
Morphologic Changes |
Class |
|---|---|
|
nil by all techniques |
Ia |
|
normal by light microscopy; deposits on IF or EM |
Ib |
|
mesangial widening and/or mild hypercellularity |
IIa |
|
moderate hypercellularity |
IIb |
|
focal segmental with active, necrotizing lesions |
IIIa |
|
focal segmental with active and sclerosing lesions |
IIIb |
|
focal segmental with sclerosing lesions |
IIIc |
|
diffuse without segmental lesions |
IVa |
|
diffuse with active, necrotizing lesions |
IVb |
|
diffuse with active and sclerosing lesions |
IVc |
|
diffuse with sclerosing lesions |
IVd |
|
pure membranous |
Va |
|
membranous + Class II |
Vb |
|
membranous + Class III |
Vc |
|
membranous + Class IV |
Vd |
|
advanced sclerosing |
VI |
where:
• Focal segmental glomerulonephritis is associated with mild or moderate alterations of the mesangium.
• Diffuse glomerulonephritis is associated with severe mesangial, endocapillary, or mesangio-capillary proliferation and/or extensive subendothelial deposits.
|
Class |
Management (Fine, 2005) |
|---|---|
|
I |
no specific therapy |
|
II |
no specific therapy |
|
III |
mild - none or glucocorticoids; severe: immunosuppression |
|
IV |
immunosuppression |
|
V |
glucocorticoids with or without cyclosporine |
|
VI |
no specific therapy |
Immunosuppressive regimen consists of:
(1) induction with cyclophosphamide or mycophenolate mofetil
(2) maintenance with mycophenolate mofetil or azathioprine
Purpose: To evaluate a renal biopsy for morphologic changes as described in the WHO classification of lupus nephritis.
Specialty: Nephrology, Clinical Laboratory, Immunology/Rheumatology
Objective: laboratory tests, severity, prognosis, stage
ICD-10: M32.1, N08,
