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.

Additional:

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.

Notes:
  • 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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