Classification of lupus nephritis.
OBJECTIVE
Lupus nephritis manifests as diverse patterns of immune complex-mediated renal disease affecting glomerular, tubulointerstitial, and vascular compartments. This review will focus on the most recent classification, the 'International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 Classification of Lupus Nephritis', and will briefly discuss other types of renal disease seen in patients with systemic lupus erythematosus.


RESULTS
The ISN/RPS 2003 Classification of lupus nephritis includes multiple changes from its predecessors, most notably removal of the subclasses of lupus nephritis class V (i.e. Va-Vd), elimination of the normal category (WHO class I), clearer definitions for all classes, a standard approach to sclerotic glomeruli, and the division of lupus nephritis class IV into subcategories based on whether the endocapillary involvement is predominantly segmental (lupus nephritis IV-S) or global (lupus nephritis IV-G). These changes have led to a higher level of interobserver reproducibility and a significant increase in the number of cases of class IV, with a reciprocal decline in lupus nephritis class III and lupus nephritis class V. Multiple studies have found that lupus nephritis class IV-S has similar or better outcomes than lupus nephritis class IV-G.


CONCLUSIONS
The ISN/RPS 2003 classification of lupus nephritis is gaining widespread acceptance and appears to be achieving its goals of reproducibility and clinical relevance.
Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA. gsm17@columbia.edu
Glen S
GS
Markowitz
Vivette D
VD
D'Agati
D000818:Animals; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology; D049109:Cell Proliferation; D005920:Glomerular Mesangium / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology; D006801:Humans; D008181:Lupus Nephritis / Q000145:classification* / Q000473:pathology; D009395:Nephritis, Interstitial / Q000473:pathology; D015588:Observer Variation; D050199:Podocytes / Q000473:pathology
D019268:Antibodies, Antineutrophil Cytoplasmic