Volume 65, Issue 2, Pages (February 2004)

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Presentation transcript:

Volume 65, Issue 2, Pages 521-530 (February 2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited Jan J. Weening, Vivette D. D'agati, Melvin M. Schwartz, Surya V. Seshan, Charles E. Alpers, Gerald B. Appel, James E. Balow, J.A.N. A. Bruijn, Terence Cook, Franco Ferrario, Agnes B. Fogo, Ellen M. Ginzler, L.E.E. Hebert, Gary Hill, Prue Hill, J. Charles Jennette, Norella C. Kong, Philippe Lesavre, Michael Lockshin, Lai-Meng Looi, Hirofumi Makino, Luiz A. Moura, Michio Nagata, ON Behalf of the International Society of Nephrology and Renal Pathology Society Working Group on the Classification Oflupus Nephritis Kidney International Volume 65, Issue 2, Pages 521-530 (February 2004) DOI: 10.1111/j.1523-1755.2004.00443.x Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 1 Lupus nephritis class II. Light micrograph of a glomerulus with mild mesangial hypercellularity [periodic-acid Schiff (PAS)]. Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 2 Lupus nephritis class III (A). Light micrograph showing a glomerulus with segmental endocapillary hypercellularity, mesangial hypercellularity, capillary wall thickening and early segmental capillary necrosis (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 3 Lupus nephritis class III (A). Light micrograph showing a glomerulus with segmental capillary necrosis with sparing of the remainder of the capillary tuft, a vasculitis-like lesion (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 4 Lupus nephritis class IV-G (A). Light micrograph showing a glomerulus with global involvement of endocapillary and mesangial hypercellularity and matrix expansion, influx of leukocytes, and occasional double contours (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 5 Lupus nephritis class IV-S (A). Segment of a glomerulus showing endocapillary hypercellularity, capillary wall double contours, wireloop lesions and hyaline thrombi [periodic-acid Schiff (PAS)]. Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 6 Lupus nephritis class IV-G (A/C). Light micrograph of a glomerulus showing global severe endo- and extracapillary proliferation, wireloop lesions, leukocyte influx, apoptotic bodies, capillary necrosis, and mesangial expansion with hypercellularity and matrix expansion; marked interstitial inflammatory infiltration [periodic-acid Schiff (PAS)]. Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 7 Lupus nephritis class IV-G (A/C). Glomerulus with global endocapillary proliferation, leukocyte influx, and apoptotic bodies, double contours, crescent formation with tubular transformation, early sclerosis, and disruption of Bowman's capsule [periodic-acid Schiff (PAS)]. Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 8 Lupus nephritis class IV-G (A). Glomerulus with widespread subendothelial immune deposits (wireloop lesions) associated with new basement membrane formation along the inner side of the capillaries, but without endocapillary leukocyte infiltration or hypercellularity (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 9 Lupus nephritis class V. Glomerulus with advanced stage lupus membranous nephropathy characterized by massive subepithelial accumulation of immune deposits (IF, full house) and interdigitating spike formation (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 10 Lupus nephritis class IV and V (A/C). Glomerulus with lupus membranous nephritis with subepithelial spike formation combined with global endocapillary and mesangial hypercellularity, early crescent formation, and early mesangial and capillary sclerosis (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 11 Lupus nephritis class VI. Renal cortex showing almost diffuse, global glomerular sclerosis accompanied by interstitial fibrosis, mononuclear inflammatory infiltrates, and vascular sclerosis (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 12 Thrombotic microangiopathy in a patient with systemic lupus erythematosus (SLE) and circulating lupus anticoagulant. A glomerulus showing severe capillary and arteriolar thrombosis, endothelial cell swelling and necrosis, neutrophil influx, and stasis of erythrocytes, without evidence of immune deposits by immunofluorescence (methenamine silver). Kidney International 2004 65, 521-530DOI: (10.1111/j.1523-1755.2004.00443.x) Copyright © 2004 International Society of Nephrology Terms and Conditions