Fogo, Ch. 8 - Lupus Nephritis Flashcards
How many lupus patients manifest renal disease?
About half manifest clinical symptoms, while 90% have altered renal findings at autopsy.
Class I lupus nephritis
Minimal mesangial
Normal glomeruli but immune deposits by IF/EM
Class II lupus nephritis
Mesangial proliferative
Mesangial hypercellularity or matrix expansion with mesangial deposits. Can have subendothelial/subepithelial.
Class III lupus nephritis
Focal
Active or chronic focal, segmental, or global endocapillary/extracapillary involving <50% of glomeruli.
Class IV lupus nephritis
Diffuse
Active or inactive diffuse segmental or global involving >50% of all glomeruli.
(*Split between diffuse segmental or diffuse global*)
Class V lupus nephritis
Membranous
Subepithelial immune deposits involving >50% of glomeruli (with or without mesangial involvement). No significance for prognosis?
(Can be diagnosed in combination with III/IV)
Class VI lupus nephritis
Advanced sclerosing
>90% of glomeruli globally sclerosed without residual activity
What active lesions can be seen in lupus nephritis?
Endocapillary hypercellularity
Karyorrhexis
Fibrinoid necrosis
Rupture of GBM
Crescents
Subendothelial deposits (wire loops)
Intraluminal immune aggregates (hyaline thrombi)
What chronic lesions can be seen in lupus nephritis?
Glomerular sclerosis (segmental or global)
Fibrous adhesions
Fibrous crescents
How do patients with lupus nephritis present?
Mixed nephrotic and nephritic patterns
What immunofluorescence pattern is seen in Class III/IV/V lupus nephritis?
“Full-house” (IgG/A/M, C3, C1q) subendothelial deposits.
At what classes is tubular atrophy and interstitial fibrosis prominent?
Class IV and up.
What tubular changes are seen in later lupus nephritis?
Cytoplasmic hyaline droplets, hydropic degeneration, vacuolization.
What are tubuloreticular inclusions?
Endothelial cytoplasmic inclusions that are often found in SLE, but also in AIDS and other viral infections. Reflects high levels of interferon?
How can membranous lupus nephritis (class V) be distinguished from membranous nephropathy?
Full-house immunofluorescence and absence of staining for the phospholipase A2 receptor.
