According to WHO, membranous glomerulonephritis seen in SLE, is-
Ans. is 'd' i.e., Class V KIDNEY INVOLVEMENT IN SLE (LUPUS NEPHRITIS) A. Glomerular disease There are several versions of WHO classification of lupus nephritis ? 1. Minimal or no detectable abnormalities (class 1) o It occurs in less than 5% of patients. o Has best prognosis. 2.Mesangial lupus glomerulonephritis (class H) o Characterized by mesangial cell proliferation and lack of involvement of glomerular capillary wall. Granular mesangial deposits of immunoglobule and complement ---> the earliest change of lupus nephritis and is found in all type of lupus nephritis. Has good prognosis. 3. Focal proliferative glomerulonephritis (class III) o Affecting fewer than 50% of glomeruli. o Deposits are predominantly subendothelial, i.e between endothelium and basement membrane. o Granular deposits also occur in mesangium as occur in all form of lupus nephritis. 4.Diffuse proliferative glomerulonephritis (class IV) o Most common form of lupus nephritis (35-60% of patients). Most or all glomeruli are involved. o Deposits are predominantly subendothelial. o Granular deposits in mesangium. o Epithelial crescents are seen in the Bowman space. o Has worst prognosis. 5. Membranous glomerulonephritis (class V) o There is widespread thickning of capillary walls. o Deposits are primarily subepithelial, i.e. between epithelium and basement membrane. o Granular deposits in mesangium. B. Tubulointerstitial disease o Though glomeruli are involved primarily in lupus nephritis, interstitium and tubules can also be involved especially in association with diffuse proliferative glomerulonephritis. o Granular deposition of immunoglobulin and complement in tubular basement membrane are seen. Anti-DNA antibodies is usually associated with active lupus nephritis Also know o Nephritis is the most serious manifestation of SLE. o Most common cause of death is renal failure due to nephritis.
Class II
Class III
Class IV
Class V