What is the WHO classifications of Lupus Nephritis?

Classifications of Lupus Nephritis(LN):

Renal involvement occurs in 1/3rd of SLE, of these20%- 25% develop end stage renal failure within 10 years. Lupus nephritis is classified histologically by WHO which was updated by the International Society of Nephrology/Renal Pathological Society in 2004. It describes histological classifications as well as clinical features of individual classes:

History of Classification:

The World Health Organization (WHO) workshop in 1974 first outlined several distinct patterns of lupus-related glomerular injury; these were modified in 1982. In 2004 the International Society of Nephrology in conjunction with the Renal Pathology Society again updated the classification. And it is the latest version.


What is the treatment option of each types of LN?

  • Type I—no treatment
  • Type II— usually runs a benign course but some patients are treated with hydroxychloroquine and/or steroids alone.
  • Type III, IV and V—immunosuppressive therapy with steroid and cyclophosphamide or mycophenolate mofetil (MMF) are used for induction. Then azathioprine and mycophenolate mofetil are used for maintenance
  • Type VI – Dialysis or renal transplantation.
  • Rituximab (anti CD-20) may be used in some patient
  • All the symptomatic (hypertension and edema) patients should be treated accordingly.

  • Focal glomerulonephritis respond well to treatment with prednisolone 40 to 60 mg/day.
  • Diffuse and membranous lesions do not respond well to steroid only. Pulse therapy with methylprednisolone for 3 days followed by maintenance with prednisolone is necessary. Sometimes azathioprine 2 to 3 mg/kg body weight or cyclophosphamide 100 to 150 mg daily with prednisolone may be given.

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