AJKD Atlas of Renal Pathology: Focal and Diffuse Lupus Nephritis (ISN/RPS Class III and IV) Agnes B. Fogo, MD, Mark A. Lusco, MD, Behzad Najafian, MD, Charles E. Alpers, MD American Journal of Kidney Diseases Volume 70, Issue 2, Pages e9-e11 (August 2017) DOI: 10.1053/j.ajkd.2017.06.001 Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions
Figure 1 Focal lupus nephritis ISN/RPS class III with focal (<50%) glomerular involvement with active lesions. Some glomeruli have only minor mesangial expansion, whereas others have marked segmental endocapillary hypercellularity and even necrosis (blue arrow) (Jones silver stain). Adapted from AJKD 31(6):e1-e2.2. American Journal of Kidney Diseases 2017 70, e9-e11DOI: (10.1053/j.ajkd.2017.06.001) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions
Figure 2 Diffuse lupus nephritis ISN/RPS class IV with diffuse (≥50%) glomerular involvement with active lesions. Most glomeruli have mild mesangial expansion and mild segmental endocapillary hypercellularity. One glomerulus has marked segmental hypercellularity and small cellular crescent with rupture of Bowman capsule and necrosis extending to the arteriole (Jones silver stain). Adapted from AJKD 31(6):e1-e2.2. American Journal of Kidney Diseases 2017 70, e9-e11DOI: (10.1053/j.ajkd.2017.06.001) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions
Figure 3 Diffuse lupus nephritis ISN/RPS class IV with chronicity with moderate interstitial fibrosis, glomerulosclerosis, and fibrocellular crescent, and activity with segmental endocapillary hypercellularity (periodic acid–Schiff stain). Adapted from AJKD 31(6):e1-e2.2. American Journal of Kidney Diseases 2017 70, e9-e11DOI: (10.1053/j.ajkd.2017.06.001) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions
Figure 4 Diffuse lupus nephritis ISN/RPS class IV with sausage-shaped capillary wall deposits with smooth outer contours, indicative of subendothelial deposits, and scattered small granular capillary walls deposits, likely subepithelial deposits, and occasional mesangial deposits (immunofluorescence microscopy, IgG). Adapted from AJKD 31(6):e1-e2.2. American Journal of Kidney Diseases 2017 70, e9-e11DOI: (10.1053/j.ajkd.2017.06.001) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions
Figure 5 Diffuse lupus nephritis ISN/RPS class IV with subepithelial and subendothelial deposits (electron microscopy). Mesangial deposits are not shown in this image. Adapted from AJKD 31(6):e1-e2.2. American Journal of Kidney Diseases 2017 70, e9-e11DOI: (10.1053/j.ajkd.2017.06.001) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions
Figure 6 Diffuse lupus nephritis ISN/RPS class III with subendothelial, intramembranous, and subepithelial deposits with reticular aggregates within endothelial cell cytoplasm (electron microscopy). Adapted from AJKD 31(6):e1-e2.2. American Journal of Kidney Diseases 2017 70, e9-e11DOI: (10.1053/j.ajkd.2017.06.001) Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions