The classification of glomerulonephritis in systemic lupus erythematosus revisited.
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 <50% of total number of glomeruli) with subdivisions for active and sclerotic lesions; class IV for diffuse glomerulonephritis (involving > or = 50% 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.
Weening
Jan J
JJ
Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands. j.j.weening@amc.uva.nl
D'Agati
Vivette D
VD
Schwartz
Melvin M
MM
Seshan
Surya V
SV
Alpers
Charles E
CE
Appel
Gerald B
GB
Balow
James E
JE
Bruijn
Jan A
JA
Cook
Terence
T
Ferrario
Franco
F
Fogo
Agnes B
AB
Ginzler
Ellen M
EM
Hebert
Lee
L
Hill
Gary
G
Hill
Prue
P
Jennette
J Charles
JC
Kong
Norella C
NC
Lesavre
Philippe
P
Lockshin
Michael
M
Looi
Lai-Meng
LM
Makino
Hirofumi
H
Moura
Luiz A
LA
Nagata
Michio
M
D001706:Biopsy; D005921:Glomerulonephritis / Q000145:classification* / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications*