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LE DIVERSE CLASSI DELLA GLOMERULONEFRITE
LE DIVERSE CLASSI DELLA GLOMERULO NEFRITE
RENE: le alterazioni istologiche a carico del rene sono presenti nel 100% dei pz con lupus, tuttavia la sintomatologia si presenta solo nel 50% dei casi. Si identificano cinque classi:
World Health Organization (WHO) morphologic classification of lupus nephritis (modified in 1982)
Class I Normal glomeruli
a. Nil (by all techniques)
b. Normal by light microscopy, but deposits by electron or immunofluorescence microscopy
Active glomerular lesions
Endocapillary hypercellularity with or without leukocyte
infiltration and with substantial luminal reduction
Karyorrhexis
Fibrinoid necrosis
Rupture of glomerular basement membrane
Crescents, cellular or fibrocellular
Subendothelial deposits identifiable by light microscopy (wireloops)
Intraluminal immune aggregates (hyaline thrombi)
Chronic glomerular lesions
Glomerular sclerosis (segmental, global)
Fibrous adhesions
Fibrous crescents
Class II Pure mesangial alterations (mesangiopathy)
a. Mesangial widening and/or mild hypercellularity
b. Moderate hypercellularity
Class III Focal segmental glomerulonephritis
a. With “active” necrotizing lesions
b. With “active” and sclerosing lesions
c. With sclerosing lesions
Class IV Diffuse glomerulonephritis
a. Without segmental lesions
b. With “active” necrotizing lesions
c. With “active” and sclerosing lesions
d. With sclerosing lesions
Class V Diffuse membranous glomerulonephritis
a. Pure membranous glomerulonephritis
b. Associated with lesions of class II
c. Associated with lesions of class III
d. Associated with lesions of class IV
Class VI Advanced sclerosing glomerulonephritis
International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification of lupus nephritis
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
Class III Focal lupus nephritis
glomerulonephritis involving 50% of all glomeruli, typically with focal subendothelial immune deposits,
-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
glomerulonephritis involving 50% of all glomeruli, typically with diffuse subendothelial immune deposits.
-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/G (A/C)Active - chronic lesions: diffuse segmental/global proliferative - sclerosing lupus nephritis
-Class IV-S (C) Chronic inactive 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.
Class V lupus nephritis show advanced sclerosis
Class VI Advanced sclerosis lupus nephritis
90% of glomeruli globally sclerosed without residual activity
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LE DIVERSE CLASSI DELLA GLOMERULO NEFRITE
Edited by patroclotest - 4/9/2010, 10:28.