Lupus nephritis classification: Difference between revisions

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{{Lupus nephritis}}
{{Lupus nephritis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}[[User:Okamal|Omer Kamal, M.D.]][mailto:okamal@bidmc.harvard.edu <nowiki>[2]</nowiki>]
==Overview==
==Overview==
There is no established system for the classification of [disease name].
[[Lupus nephritis]] may be classified according to the Renal Pathology Society/International Society of Nephrology (RPS/ISN) classification which includes minimal mesangial lupus nephritis (class I), mesangial proliferative lupus nephritis (class II), focal lupus nephritis (class III), diffuse lupus nephritis (class IV), lupus membranous nephropathy (class V) and advanced sclerosing lupus nephritis (class VI)
 
OR
 
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
 
OR
 
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Classification==
==Classification==
The Renal Pathology Society/International Society of Nephrology (RPS/ISN) classification:<ref name="pmid147179222">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=Kidney Int. |volume=65 |issue=2 |pages=521–30 |date=February 2004 |pmid=14717922 |doi=10.1111/j.1523-1755.2004.00443.x |url=}}</ref><ref name="pmid16861976">{{cite journal |vauthors=Furness PN, Taub N |title=Interobserver reproducibility and application of the ISN/RPS classification of lupus nephritis-a UK-wide study |journal=Am. J. Surg. Pathol. |volume=30 |issue=8 |pages=1030–5 |date=August 2006 |pmid=16861976 |doi= |url=}}</ref>
The Renal Pathology Society/International Society of Nephrology (RPS/ISN) classification:<ref name="pmid147179222">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=Kidney Int. |volume=65 |issue=2 |pages=521–30 |date=February 2004 |pmid=14717922 |doi=10.1111/j.1523-1755.2004.00443.x |url=}}</ref><ref name="pmid16861976">{{cite journal |vauthors=Furness PN, Taub N |title=Interobserver reproducibility and application of the ISN/RPS classification of lupus nephritis-a UK-wide study |journal=Am. J. Surg. Pathol. |volume=30 |issue=8 |pages=1030–5 |date=August 2006 |pmid=16861976 |doi= |url=}}</ref><ref name="pmid15569330">{{cite journal |vauthors=Yokoyama H, Wada T, Hara A, Yamahana J, Nakaya I, Kobayashi M, Kitagawa K, Kokubo S, Iwata Y, Yoshimoto K, Shimizu K, Sakai N, Furuichi K |title=The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese |journal=Kidney Int. |volume=66 |issue=6 |pages=2382–8 |date=December 2004 |pmid=15569330 |doi=10.1111/j.1523-1755.2004.66027.x |url=}}</ref><ref name="pmid17264872">{{cite journal |vauthors=Markowitz GS, D'Agati VD |title=The ISN/RPS 2003 classification of lupus nephritis: an assessment at 3 years |journal=Kidney Int. |volume=71 |issue=6 |pages=491–5 |date=March 2007 |pmid=17264872 |doi=10.1038/sj.ki.5002118 |url=}}</ref><ref name="pmid19374008">{{cite journal |vauthors=Markowitz GS, D'Agati VD |title=Classification of lupus nephritis |journal=Curr. Opin. Nephrol. Hypertens. |volume=18 |issue=3 |pages=220–5 |date=May 2009 |pmid=19374008 |doi= |url=}}</ref><ref name="pmid193740082">{{cite journal |vauthors=Markowitz GS, D'Agati VD |title=Classification of lupus nephritis |journal=Curr. Opin. Nephrol. Hypertens. |volume=18 |issue=3 |pages=220–5 |date=May 2009 |pmid=19374008 |doi= |url=}}</ref>


=== Minimal mesangial lupus nephritis (class I) ===
=== Minimal mesangial lupus nephritis (class I) ===
* Very rare.<ref name="pmid147179222" />
* Very rare.<ref name="pmid147179222" />
* No microscopic finding.  
* No [[microscopic]] finding.  
* Identified on electron microscopy and immunofluorescence.<ref name="pmid147179222" />
* Identified on [[electron microscopy]] and [[immunofluorescence]].<ref name="pmid147179222" />


=== Mesangial proliferative lupus nephritis (class II) ===
=== Mesangial proliferative lupus nephritis (class II) ===
* Microscopic Hematuria
* Microscopic [[Hematuria]]
* Proteinuria
* [[Proteinuria]]
* Hypercellularity in mesangium<ref name="pmid147179222" />
* Hypercellularity in [[mesangium]]<ref name="pmid147179222" />
* Light microscopy shows subendothelial deposits or segmental scars<ref name="pmid147179222" />
* Light microscopy shows subendothelial deposits or segmental scars<ref name="pmid147179222" />
* Immunofluorescence shows subepithelial or subendothelial deposits
* [[Immunofluorescence]] shows subepithelial or subendothelial deposits
* Good prognosis
* Good prognosis


=== Focal lupus nephritis (class III) ===
=== Focal lupus nephritis (class III) ===
* Less than 50% glomeruli involved
* Less than 50% glomeruli involved
* Hematuria
* [[Hematuria]]
* Proteinuria
* [[Proteinuria]]
* Hypertension
* Hypertension
* Uniform involvement on immunofluorescence<ref name="pmid147179222" /><ref name="pmid3656940">{{cite journal |vauthors=Schwartz MM, Kawala KS, Corwin HL, Lewis EJ |title=The prognosis of segmental glomerulonephritis in systemic lupus erythematosus |journal=Kidney Int. |volume=32 |issue=2 |pages=274–9 |date=August 1987 |pmid=3656940 |doi= |url=}}</ref>
* [[Crescentic glomerulonephritis|Crescent]] formation
* Subendothelial immune and mesangial deposits on electron microscopy<ref name="pmid147179222" /><ref name="pmid14747370">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=J. Am. Soc. Nephrol. |volume=15 |issue=2 |pages=241–50 |date=February 2004 |pmid=14747370 |doi= |url=}}</ref>.   
* Uniform involvement on [[immunofluorescence]]<ref name="pmid147179222" /><ref name="pmid3656940">{{cite journal |vauthors=Schwartz MM, Kawala KS, Corwin HL, Lewis EJ |title=The prognosis of segmental glomerulonephritis in systemic lupus erythematosus |journal=Kidney Int. |volume=32 |issue=2 |pages=274–9 |date=August 1987 |pmid=3656940 |doi= |url=}}</ref>
* Subendothelial immune and [[Mesangial cell|mesangial]] deposits on electron microscopy<ref name="pmid147179222" /><ref name="pmid14747370">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=J. Am. Soc. Nephrol. |volume=15 |issue=2 |pages=241–50 |date=February 2004 |pmid=14747370 |doi= |url=}}</ref>.   


==== Subclasses on the basis of inflammatory activity of the lesions: ====
==== Subclasses on the basis of inflammatory activity of the lesions: ====
*Class III (A) called focal proliferative lupus nephritis: Just active lesions.<ref name="pmid14747370" /><ref name="pmid14717922">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=Kidney Int. |volume=65 |issue=2 |pages=521–30 |date=February 2004 |pmid=14717922 |doi=10.1111/j.1523-1755.2004.00443.x |url=}}</ref>
*Class III (A) called focal proliferative lupus [[Lupus nephritis|nephritis]]: Just active [[Lesion|lesions]].<ref name="pmid14747370" /><ref name="pmid14717922">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=Kidney Int. |volume=65 |issue=2 |pages=521–30 |date=February 2004 |pmid=14717922 |doi=10.1111/j.1523-1755.2004.00443.x |url=}}</ref>
*Class III (A/C) called focal proliferative and sclerosing lupus nephritis: Active and chronic lesions<ref name="pmid14717922" />
*Class III (A/C) called focal proliferative and sclerosing lupus [[nephritis]]: Active and chronic [[Lesion|lesions]]<ref name="pmid14717922" />
*Class III (C) called focal sclerosing lupus nephritis: Chronic inactive lesions with scarring.
*Class III (C) called focal sclerosing lupus nephritis: Chronic inactive lesions with scarring.


=== Diffuse lupus nephritis (class IV) ===
=== Diffuse lupus nephritis (class IV) ===
* More than 50% [[Glomerulus|glomeruli]] involved
* [[Proteinuria]]
* [[Hematuria]]
* [[Nephrotic syndrome]]
* [[Hypocomplementemia]]
* Increased anti-DNA [[antibodies]]
* Proliferative, necrotizing lesions
* [[Crescentic glomerulonephritis|Crescent]] formation
* Glomerular capillary wall thickening
* [[Monocytes]], suppressor/cytotoxic T cells may be seen
* Subendothelial deposits on electron microscopy
==== Subclasses on the basis of involvment of affected glomeruli: Segmental (S) or global (G) and by the inflammation ====
* Class IV-S (A), class IV-S with active lesions called diffuse segmental proliferative [[nephritis]].
* Class IV-G (A), class IV-G associated with active lesions called diffuse global proliferative [[nephritis]].
* Class IV-S (A/C),associated with active and chronic [[Lesion|lesions]] called diffuse segmental proliferative and sclerosing nephritis.
* Class IV-G (A/C), class IV-G with active and chronic [[Lesion|lesions]] called diffuse global proliferative and sclerosing nephritis.
* Class IV-S (C), associated with chronic inactive lesions with scars called diffuse segmental sclerosing lupus [[Lupus nephritis|nephritis]].
* Class IV-G (C), class IV-G with chronic inactive lesions with scars called diffuse global sclerosing [[lupus nephritis]]


=== Lupus membranous nephropathy (class V) ===
=== Lupus membranous nephropathy (class V) ===
* [[Nephrotic syndrome]]
* Microscopic [[hematuria]]
* [[Hypertension]] 
* Light microscopy shows diffuse [[Glomerulus|glomerular]] capillary wall thickening
* [[Immunofluorescence]] or electron microscopy shows subepithelial immune depositson
* May present no [[SLE]] features/Lab findings


=== Advanced sclerosing lupus nephritis (class VI) ===
=== Advanced sclerosing lupus nephritis (class VI) ===
 
* [[Proteinuria]]  
OR
* Dull [[urine]] sediment
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
* Greater than 90 percent of [[Glomerulus|glomeruli]] involvement.
**[Group1]
* Presence of all advanced stages of chronic class III, IV, or V [[lupus nephritis]].
**[Group2]
**[Group3]
**[Group4]
OR
*[Disease name] may be classified into [large number > 6] subtypes based on:
**[Classification method 1]
**[Classification method 2]
**[Classification method 3]
*[Disease name] may be classified into several subtypes based on:
**[Classification method 1]
**[Classification method 2]
**[Classification method 3]
OR
*Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
*If the staging system involves specific and characteristic findings and features:
*According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
*The staging of [malignancy name] is based on the [staging system].
OR
*There is no established system for the staging of [malignancy name].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category: (name of the system)]]
[[Category: (name of the system)]]

Latest revision as of 18:28, 20 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]

Overview

Lupus nephritis may be classified according to the Renal Pathology Society/International Society of Nephrology (RPS/ISN) classification which includes minimal mesangial lupus nephritis (class I), mesangial proliferative lupus nephritis (class II), focal lupus nephritis (class III), diffuse lupus nephritis (class IV), lupus membranous nephropathy (class V) and advanced sclerosing lupus nephritis (class VI)

Classification

The Renal Pathology Society/International Society of Nephrology (RPS/ISN) classification:[1][2][3][4][5][6]

Minimal mesangial lupus nephritis (class I)

Mesangial proliferative lupus nephritis (class II)

Focal lupus nephritis (class III)

Subclasses on the basis of inflammatory activity of the lesions:

  • Class III (A) called focal proliferative lupus nephritis: Just active lesions.[8][9]
  • Class III (A/C) called focal proliferative and sclerosing lupus nephritis: Active and chronic lesions[9]
  • Class III (C) called focal sclerosing lupus nephritis: Chronic inactive lesions with scarring.

Diffuse lupus nephritis (class IV)

Subclasses on the basis of involvment of affected glomeruli: Segmental (S) or global (G) and by the inflammation

  • Class IV-S (A), class IV-S with active lesions called diffuse segmental proliferative nephritis.
  • Class IV-G (A), class IV-G associated with active lesions called diffuse global proliferative nephritis.
  • Class IV-S (A/C),associated with active and chronic lesions called diffuse segmental proliferative and sclerosing nephritis.
  • Class IV-G (A/C), class IV-G with active and chronic lesions called diffuse global proliferative and sclerosing nephritis.
  • Class IV-S (C), associated with chronic inactive lesions with scars called diffuse segmental sclerosing lupus nephritis.
  • Class IV-G (C), class IV-G with chronic inactive lesions with scars called diffuse global sclerosing lupus nephritis

Lupus membranous nephropathy (class V)

Advanced sclerosing lupus nephritis (class VI)

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (February 2004). "The classification of glomerulonephritis in systemic lupus erythematosus revisited". Kidney Int. 65 (2): 521–30. doi:10.1111/j.1523-1755.2004.00443.x. PMID 14717922.
  2. ↑ Furness PN, Taub N (August 2006). "Interobserver reproducibility and application of the ISN/RPS classification of lupus nephritis-a UK-wide study". Am. J. Surg. Pathol. 30 (8): 1030–5. PMID 16861976.
  3. ↑ Yokoyama H, Wada T, Hara A, Yamahana J, Nakaya I, Kobayashi M, Kitagawa K, Kokubo S, Iwata Y, Yoshimoto K, Shimizu K, Sakai N, Furuichi K (December 2004). "The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese". Kidney Int. 66 (6): 2382–8. doi:10.1111/j.1523-1755.2004.66027.x. PMID 15569330.
  4. ↑ Markowitz GS, D'Agati VD (March 2007). "The ISN/RPS 2003 classification of lupus nephritis: an assessment at 3 years". Kidney Int. 71 (6): 491–5. doi:10.1038/sj.ki.5002118. PMID 17264872.
  5. ↑ Markowitz GS, D'Agati VD (May 2009). "Classification of lupus nephritis". Curr. Opin. Nephrol. Hypertens. 18 (3): 220–5. PMID 19374008.
  6. ↑ Markowitz GS, D'Agati VD (May 2009). "Classification of lupus nephritis". Curr. Opin. Nephrol. Hypertens. 18 (3): 220–5. PMID 19374008.
  7. ↑ Schwartz MM, Kawala KS, Corwin HL, Lewis EJ (August 1987). "The prognosis of segmental glomerulonephritis in systemic lupus erythematosus". Kidney Int. 32 (2): 274–9. PMID 3656940.
  8. ↑ 8.0 8.1 Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (February 2004). "The classification of glomerulonephritis in systemic lupus erythematosus revisited". J. Am. Soc. Nephrol. 15 (2): 241–50. PMID 14747370.
  9. ↑ 9.0 9.1 Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (February 2004). "The classification of glomerulonephritis in systemic lupus erythematosus revisited". Kidney Int. 65 (2): 521–30. doi:10.1111/j.1523-1755.2004.00443.x. PMID 14717922.

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