CLÍNICA/SUBTIPUS

Nefritis lúpica

  Classificació histològica nefritis lúpica:

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
There may be a few isolated subepithelial or subendothelial deposits visible by immunofluorescence or electron microscopy, but not by light microscopy

Class III Focal lupus nephritis^a,b
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^a,b
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
Class IV-G (A/C) Active and chronic lesions: diffuse global proliferative and 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, with or 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 may show advanced sclerosis
Class VI Advanced sclerosing lupus nephritis
 >=90% of glomeruli globally sclerosed without residual activity

^a Indicate the proportion of glomeruli with active and with sclerotic lesions.
^b Indicate the proportion of glomeruli with fibrinoid necrosis and with cellular crescents.
Indicate and grade (mild, moderate, severe) tubular atrophy, interstitial inflammation and fibrosis, severity of arteriosclerosis or other vascular lesions.

  Índex d'activitat:

• Proliferació cel.lular (0-3)
• Necrosi fibrinoide o cariorrexis (0-3) x2
• Semillunes (0-3) x2
• Trombus hialins o nanses de fil ferro (0-3)
• Infiltració leucocitària (0-3)
• Infiltració mononuclear tubulointersticial (0-3)

  Índex de cronicitat:

• Esclerosi glomerular (0-3)
• Semillunes fibroses (0-3)
• Fibrosi intersticial (0-3)
• Atròfia tubular (0-3)

  Tractament de la nefritis lúpica:

• ACR guidelines for screening, treatment, and management of lupus nephritis (2012)