Table 3

Revised classification lupus nephritis according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003[78]
Class I Minimal mesangial lupus nephritis
Normal glomeruli by light microscopy, but mesangial immune deposits by immunofluorescence
Class II Mesangial proliferative lupus nephritis
Purely mesangial hypercellularity of any degree or mesangial matrix expansion by light microscopy, with mesangial immune deposits
May be a few isolated subepithelial deposits visible by immunofluorescence or electron microscopy, but not by light microscopy
Class III Focal lupus nephritis
Active or inactive focal, segmental or global endo- or extracapillary glomerulonephritis involving <50% of all glomeruli, typically with focal subendothelial immune deposits, with or without mesangial alterations
Class III (A) Active lesions: focal proliferative lupus nephritis
Class III (A/C) Active and chronic lesions: focal proliferative and sclerosing lupus nephritis
Class III (C) Chronic inactive lesions with glomerular scars: focal sclerosing lupus nephritis
Class IV Diffuse lupus nephritis
Active or inactive diffuse, segmental or global endo- or extracapillary glomerulonephritis involving ≥50% of all glomeruli, typically with diffuse subendothelial immune deposits, with or without mesangial alterations. This class is divided into diffuse segmental (IV-S) lupus nephritis when ≥50% of the involved glomeruli have segmental lesions, and diffuse global (IV-G) lupus nephritis when ≥50% of the involved glomeruli have global lesions. Segmental is defined as a glomerular lesion that involves less than half of the glomerular tuft. This class includes cases with diffuse wire loop deposits but with little or no glomerular proliferation
Class IV-S (A) Active lesions: diffuse segmental proliferative lupus nephritis
Class IV-G (A) Active lesions: diffuse global proliferative lupus nephritis
Class IV-S (A/C) Active and chronic lesions: diffuse segmental proliferative and sclerosing lupus nephritis
Active and chronic lesions: diffuse global proliferative and sclerosing lupus nephritis
Class IV-S (C) Chronic active lesions with scars: diffuse segmental sclerosing lupus nephritis
Class IV-G (C) Chronic inactive lesions with scars: diffuse global sclerosing lupus nephritis
Class V Membranous lupus nephritis
Global or segmental subepithelial immune deposits or their morphologic sequelae by light microscopy and by immunofluorescence or electron microscopy, with our without mesangial alterations
Class V lupus nephritis may occur in combination with class III or IV in which case both will be diagnosed
Class V lupus nephritis show advanced sclerosis
Class VI Advanced sclerosis lupus nephritis
≥90% of glomeruli globally sclerosed without residual activity

Reprint permission was obtained from the Journal of the American Society of Nephrology.

Kronbichler and Mayer

Kronbichler and Mayer BMC Medicine 2013 11:95   doi:10.1186/1741-7015-11-95

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