What is the classification of systemic lupus erythematosus (SLE) nephritis?

Updated: Aug 04, 2021
  • Author: Christie M Bartels, MD, MS; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The ISN/RPS published revisions to the World Health Organization (WHO) classification for lupus nephritis in 2003. The classification is based on light microscopy, electron microscopy, and immunofluorescence findings from renal biopsy results, as summarized in the table below. [107]

Table 4. International Society of Nephrology 2003 Revised Classification of SLE Nephritis (Open Table in a new window)

Class

Classification

Features

Class I

Minimal mesangial

Normal light microscopy findings; abnormal electron microscopy findings

Class II

Mesangial proliferative

Hypercellular on light microscopy

Class III

Focal proliferative

< 50% of glomeruli involved

Class III lupus nephritis is further subclassified as follows:

  • Class III (A), focal proliferative: Active lesions

  • Class III (A/C), focal proliferative and sclerosing: Active and chronic lesions

  • Class III (C ) (focal sclerosing): Chronic lesions

Class IV

Diffuse proliferative

=50% of glomeruli involved; classified segmental or global; treated aggressively

Class IV lupus nephritis is also further subclassified, as follows:

  • Class IV-S: Diffuse segmental proliferative

  • Class IV-G: Diffuse global proliferative

  • Class IV-S or IV-G, active (A) or chronic (C)

Note: It remains to be determined whether further subcategories have a prognostic difference. [108] There are conflicting data from studies; some investigators report that class IV-G (A) has a better prognosis relative to class IV-S (A/C), which is less responsive to treatment.

Class V

Membranous

Predominantly nephrotic disease

Note: Class V may occur with class III or IV (then, both cases would be diagnosed) [102]

Class VI

Advanced sclerosing

=90% of glomeruli involved without residual activity [102]

Chronic lesions and sclerosis

Source  (except as noted otherwise) Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. Feb 2004;15(2):241-50. [109]

SLE = systemic lupus erythematosus.


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