The World Health Organization (WHO) developed a morphologic classification for lupus nephritis.
(1) mesangial changes
(2) membranous change
(3) deposits on immunofluorescence (IF) and/or electron microscopy (EM)
(6) active lesions
(I) normal glomeruli
(II) pure mesangial alterations
(III) focal segmental glomerulonephritis
(IV) diffuse glomerulonephritis
(V) diffuse membranous glomerulonephritis
(VI) advanced sclerosing glomerulonephritis
nil by all techniques
normal by light microscopy; deposits on IF or EM
mesangial widening and/or mild hypercellularity
focal segmental with active, necrotizing lesions
focal segmental with active and sclerosing lesions
focal segmental with sclerosing lesions
diffuse without segmental lesions
diffuse with active, necrotizing lesions
diffuse with active and sclerosing lesions
diffuse with sclerosing lesions
membranous + Class II
membranous + Class III
membranous + Class IV
• 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.
Management (Fine, 2005)
no specific therapy
mild - none or glucocorticoids; severe: immunosuppression
glucocorticoids with or without cyclosporine
Immunosuppressive regimen consists of:
(1) induction with cyclophosphamide or mycophenolate mofetil
(2) maintenance with mycophenolate mofetil or azathioprine
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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,