Classifications of Lupus Nephritis(LN):
Renal involvement occurs in 1/3rd of SLE, of these 20%- 25%
develop end-stage renal failure within 10 years. Lupus nephritis was, at first 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 the option of each type 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) is 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 oedema) patients should be treated accordingly.
Notes:
- Focal glomerulonephritis responds 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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