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Back| Classification | Description | |
|---|---|---|
| I | Minimal Mesangial LN | Normal light microscopy, mesangial immune complex deposits visible on immunofluorescence and electron microscopy |
| II | Mesangial Proliferative LN | Mildest form, best prognosis, slight proteinuria and hematuria, good renal function, good response to GC. |
| III | Focal LN | <50% of glomeruli affected. Focal and segmental proliferation on a background of diffuse mesangial proliferation, with necrosis, slight to moderate proteinuria; |
| IV | Diffuse Segmental (IV-S) or Diffuse Global (IV-G) LN | ≥50% of glomeruli affected. Most severe, heavy proteinuria, hematuria, tubular casts, active lesions may respond to aggressive treatment; |
| V | Membranous LN | Thickening of glomerular basement membrane, spike formation, mild mesangial cell proliferation, mainly presents as NS; if combined with type III or IV, should be diagnosed separately. |
| VI | Advanced Sclerosing LN | ≥90% of glomeruli show global sclerosis, without residual active lesions. |
Explanation
LN significantly affects the prognosis of SLE, with renal failure being one of the main causes of death in SLE. Pathological types I and II of LN have a better prognosis, while types IV and VI have a poorer prognosis.
ISN/RPS: International Society of Nephrology/Renal Pathology Society.
Renal involvement, also known as lupus nephritis (LN), manifests as proteinuria, hematuria, tubular casts, and even renal failure.
Renal pathology can provide activity indicators of LN, including glomerular proliferative changes, fibrinoid necrosis, karyorrhexis, cellular crescents, hyaline thrombi, wire loops, inflammatory cell infiltration, and tubulointerstitial inflammation;
Chronic indicators of LN include glomerular sclerosis, fibrous crescents, tubular atrophy, and interstitial fibrosis. High activity indicators suggest rapid progression of renal damage, but aggressive treatment can reverse it;
Chronic indicators suggest irreversible renal damage, and drug treatment can only slow down but not reverse the continued increase of chronic indices.
