A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath. She has a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, there is a maculopapular rash on her face, JVP is 4 cm, heart sounds normal, lungs clear, and there is pedal and periorbital edema. Her creatinine is very high, a urinalysis reveals many RBCs and RBC casts. A renal biopsy is performed.For the above patient with GN, select the most likely diagnosis on renal biopsy.
Systemic lupus erythematosus (SLE) can cause a wide variety of renal disorders, and can progress to ESRF. Because of the active urine sediment this individual has a proliferative GN. It is difficult to diagnose the type of glomerular involvement in SLE without a biopsy. Based on the biopsy results lupus nephritis (LN) is divided into 6 classes (WHO classification). Class I, minimal mesangial LN; Class II, mesangial proliferative LN; Class III, focal LN; Class TV, diffuse segmental LN; Class V, membranous LN; and Class VI, advanced sclerosing LN.
diffuse proliferative GN
crescentic GN
focal proliferative GN
membranoproliferative GN
Oncology