title: The Revisited Classification of GN in SLE at 10 Years: Time to Re-Evaluate Histopathologic Lesions.
abstract: Over 10 years have passed since the latest revision of the histopathologic classification of lupus nephritis. This revision was a significant improvement compared with the previous version, mainly because of clearer and more concise definitions and the elimination of mixed subclasses. Despite these improvements, there are still some difficulties in the classification for lupus nephritis, many of which are in the definitions provided. In this review, we focus on the difficulties surrounding the evaluation of classes III and IV lesions, particularly the definitions of endocapillary and extracapillary proliferation, the use of the terms endocapillary proliferation and hypercellularity, the clinical relevance of segmental and global subdivision in class IV, and the value of distinguishing lesions that indicate activity and chronicity. Vascular and tubulointerstitial lesions are also discussed. Furthermore, we give an overview of the history of the classification to provide background on the origin and development of the definitions in lupus nephritis. The issues raised in this review as well as the suggestions for improvements may assist with a revision of the lupus nephritis classification in the near future.
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; s.wilhelmus@lumc.nl.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wilhelmus
authors.affiliation: Department of Pathology, University of Washington, Seattle, Washington;
authors.forename: Charles E
authors.initials: CE
authors.lastname: Alpers
authors.affiliation: Department of Medicine, Centre for Complement and Inflammation Research, Imperial College London, London, United Kingdom;
authors.forename: H Terence
authors.initials: HT
authors.lastname: Cook
authors.affiliation: Nephropathology Center, San Gerardo Hospital, Monza, Italy;
authors.forename: Franco
authors.initials: F
authors.lastname: Ferrario
authors.affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee;
authors.forename: Agnes B
authors.initials: AB
authors.lastname: Fogo
authors.affiliation: Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California;
authors.forename: Mark
authors.initials: M
authors.lastname: Haas
authors.affiliation: Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan;
authors.forename: Kensuke
authors.initials: K
authors.lastname: Joh
authors.affiliation: Department of Pathology, Necker Hospital, French National Institutes of Health and Medical Research, Paris, France; and.
authors.forename: Laure-Hélène
authors.initials: LH
authors.lastname: Noël
authors.affiliation: Department of Pathology, Weill Cornell Medical College, New York, New York.
authors.forename: Surya V
authors.initials: SV
authors.lastname: Seshan
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands;
authors.forename: Jan A
authors.initials: JA
authors.lastname: Bruijn
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands;
authors.forename: Ingeborg M
authors.initials: IM
authors.lastname: Bajema
mesh_terms: D001706:Biopsy; D002196:Capillaries / Q000473:pathology*; D049109:Cell Proliferation; D002908:Chronic Disease; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology*; D008181:Lupus Nephritis / Q000145:classification* / Q000473:pathology*; D009626:Terminology as Topic
keywords: erythematosus; lupus nephritis; renal biopsy; renal pathology; systemic lupus