A characteristic histologic feature of class IV lupus nephritis is
The glomerular diseases of patients with systemic lupus erythematosus (SLE) are many and include mesangial lupus glomerulonephritis (GN), focal or diffuse proliferative GN, and membranous GN. The World Health Organization (WHO) classifies SLE renal disease into five classes as follows: class I = no changes; class II = mesangial GN; class III = focal proliferative GN; class IV = diffuse proliferative GN (the most common class); class V = diffuse membranous GN. All of these glomerular diseases are the result of the deposition of immune complexes (DNA-anti-DNA complexes) that may be in a mesangial, intramembranous, subepithelial, or subendothelial location. In membranous lupus GN, the deposits are in a subepithelial location, while in diffuse proliferative lupus GN (WHO class IV) the deposits are mainly in a subendothelial location and produce a characteristic "wire-loop" appearance due to thickening of the capillary wall. None of these changes are specific for lupus In contrast to the "wire-loop" appearance of the glomerular capillaries with lupus nephritis, "holly leaf" mesangial deposits are seen with focal segmental GN (IgA deposits suggests Berger disease), "spike and dome" appearance of the basement membrane is seen with membranous glomerulonephropathy, a "string of popcorn" immunofluorescence pattern is also seen with membranous glomerulonephropathy, and "tram-track" splitting of the basement membrane is seen with both types of membranoproliferative GN. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition
"Holly leaf" mesangial deposits
"Spike and dome" appearance of the basement membrane
"Wire-loop" appearance of the glomerular capillaries
"Tram-track" splitting of the basement membrane
miscellaneous