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J Am Soc Nephrol 15:241-250, 2004
© 2004 American Society of Nephrology


SPECIAL FEATURE

The Classification of Glomerulonephritis in Systemic Lupus Erythematosus Revisited

Jan J. Weening*, Vivette D. D’Agati{dagger}, Melvin M. Schwartz{ddagger}, Surya V. Seshan§, Charles E. Alpers||, Gerald B. Appel, James E. Balow#, Jan A. Bruijn**, Terence Cook{dagger}{dagger}, Franco Ferrario{ddagger}{ddagger}, Agnes B. Fogo§§, Ellen M. Ginzler||||, Lee Hebert¶¶, Gary Hill##, Prue Hill***, J. Charles Jennette{dagger}{dagger}{dagger}, Norella C. Kong{ddagger}{ddagger}{ddagger}, Philippe Lesavre§§§, Michael Lockshin§, Lai-Meng Looi||||||, Hirofumi Makino¶¶¶, Luiz A. Moura### and Michio Nagata**** on behalf of the International Society of Nephrology and Renal Pathology Society Working Group on the classification of lupus nephritis

*Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands; {dagger}Columbia University, College of Physicians and Surgeons, New York, New York; {ddagger}Rush Medical College, Chicago, Illinois; §Weill Medical College, Cornell University, New York, New York; ||University of Washington, Seattle, Washington; Columbia Presbyterian Medical Center, New York, New York; #National Institutes of Health, Bethesda, Maryland; **Leiden University Medical Center, Leiden, The Netherlands; {dagger}{dagger}Imperial College Medical School, London, United Kingdom; {ddagger}{ddagger}San Carlo Borromeo Hospital, Milan, Italy; §§Vanderbilt University, Nashville, Tennessee; ||||SUNY Health Science Center, Brooklyn, New York; Ohio State University, Columbus, Ohio; ##Georges Pompidou European Hospital, Paris, France; ***St. Vincent’s Hospital, Fitzroy, Victoria, Australia; {dagger}{dagger}{dagger}University of North Carolina School of Medicine, Chapel Hill, North Carolina; {ddagger}{ddagger}{ddagger}University Kebangsaan Malaysia, Kuala Lumpur, Malaysia; §§§Necker Hospital, Paris, France; ||||||University of Malaya Medical School, Kuala Lumpur, Malaysia; Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan; ###Federal University of Sao Paulo, Sao Paulo, Brazil; and ****University of Tsubuka, Ibaraki, Japan

Correspondence to Dr. Jan J. Weening, Department of Pathology, Academic Medical Center University of Amsterdam, PO Box 22660, 1006 AZ Amsterdam, The Netherlands. Phone: 3120566410; Fax: 31206960389; E-mail: j.j.weening{at}amc.uva.nl

ABSTRACT. The currently used classification reflects our understanding of the pathogenesis of the various forms of lupus nephritis, but clinicopathologic studies have revealed the need for improved categorization and terminology. Based on the 1982 classification published under the auspices of the World Health Organization (WHO) and subsequent clinicopathologic data, we propose that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving <50% of total number of glomeruli) with subdivisions for active and sclerotic lesions; class IV for diffuse glomerulonephritis (involving >=50% of total number of glomeruli) either with segmental (class IV-S) or global (class IV-G) involvement, and also with subdivisions for active and sclerotic lesions; class V for membranous lupus nephritis; and class VI for advanced sclerosing lesions]. Combinations of membranous and proliferative glomerulonephritis (i.e., class III and V or class IV and V) should be reported individually in the diagnostic line. The diagnosis should also include entries for any concomitant vascular or tubulointerstitial lesions. One of the main advantages of the current revised classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and lending a basis for further clinicopathologic studies. We hope that this revision, which evolved under the auspices of the International Society of Nephrology and the Renal Pathology Society, will contribute to further advancement of the WHO classification.




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M. B. Stokes, K. Foster, G. S. Markowitz, F. Ebrahimi, W. Hines, D. Kaufman, B. Moore, D. Wolde, and V. D. D'Agati
Development of glomerulonephritis during anti-TNF-{alpha} therapy for rheumatoid arthritis
Nephrol. Dial. Transplant., July 1, 2005; 20(7): 1400 - 1406.
[Abstract] [Full Text] [PDF]


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LupusHome page
F Daikha-Dahmane, J P Bault, D Molina-Gomes, D Hillion, and Y Ville
Lupus erythematosus proliferative glomerulonephritis in fetus
Lupus, April 1, 2005; 14(4): 326 - 327.
[Abstract] [PDF]


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J. Am. Soc. Nephrol.Home page
T.-M. Chan, K.-C. Tse, C. S.-O. Tang, M.-Y. Mok, F.-K. Li, and for the Hong Kong Nephrology Study Group
Long-Term Study of Mycophenolate Mofetil as Continuous Induction and Maintenance Treatment for Diffuse Proliferative Lupus Nephritis
J. Am. Soc. Nephrol., April 1, 2005; 16(4): 1076 - 1084.
[Abstract] [Full Text] [PDF]


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LupusHome page
M Turkmen, A Soylu, K Demir, B Kasap, S Sarioglu, and S Kavukcu
Letter to the Editor
Lupus, February 1, 2005; 14(2): 171 - 173.
[PDF]


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LupusHome page
E J Lewis and M M Schwartz
Pathology of lupus nephritis
Lupus, January 1, 2005; 14(1): 31 - 38.
[Abstract] [PDF]


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J. Am. Soc. Nephrol.Home page
F. A. Houssiau
Management of Lupus Nephritis: An Update
J. Am. Soc. Nephrol., October 1, 2004; 15(10): 2694 - 2704.
[Full Text] [PDF]


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NEJMHome page
M. J. Somers, G. H. Daouk, and R. T. McCluskey
Case 11-2004 - A Boy with Rash, Edema, and Hypertension
N. Engl. J. Med., April 8, 2004; 350(15): 1550 - 1559.
[Full Text] [PDF]


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Rheumatology (Oxford)Home page
Robin Goodfellow (43-4)
Rheumatology, April 1, 2004; 43(4): 540 - 540.
[Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
R. J. Glassock
Reclassification of Lupus Glomerulonephritis: Back to the Future
J. Am. Soc. Nephrol., February 1, 2004; 15(2): 501 - 503.
[Full Text] [PDF]




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