Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions

Rheumatology (Oxford). 2008 May;47(5):702-7. doi: 10.1093/rheumatology/ken019. Epub 2008 Apr 4.


Objectives: To determine if the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification of lupus nephritis (LN) is helpful in predicting renal outcome.

Methods: A total of 92 patients with LN who underwent renal biopsy in our hospital were re-classified according to the ISN/RPS 2003 criteria.

Results: The mean patient age was 36.8 yrs and the median observation period was 65 months. The relative frequency for each class was as follows: Class I (minimal mesangial LN) 0%, Class II (mesangial proliferative LN) 13%, Class III (focal LN) 17%, Class IV (diffuse LN) 60% and Class V (membranous LN) 10%. Within Class IV, diffuse segmental (Class IV-S) was 25% and diffuse global (Class IV-G) 75%. During the observation period, renal function was more likely to deteriorate in Class IV-G cases than in Class IV-S cases. Importantly, when Class IV-G was subdivided into cases involving active lesion alone [IV-G (A)] or chronic lesion [IV-G (A/C)], the majority of cases in IV-G (A) was nephrotic, but responded well to therapy. In contrast, renal function declined only in IV-G (A/C) cases. Patients with Class IV-G (A/C) had persistent proteinuria in spite of intensified therapies. Moreover, the higher proportion of chronic lesions was related with the deterioration of renal function.

Conclusions: This study showed that in Class IV-G cases, renal outcome differed in the presence of chronicity. Chronicity could be a critical factor in predicting outcome. Thus, the revised classification of LN is clinically valuable in identifying different renal outcomes among patients with diffuse LN.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Chronic Disease
  • Creatinine / blood
  • Female
  • Humans
  • Kidney Failure, Chronic / pathology
  • Kidney Glomerulus / pathology
  • Kidney Glomerulus / physiopathology
  • Lupus Nephritis / classification*
  • Lupus Nephritis / pathology
  • Lupus Nephritis / physiopathology
  • Male
  • Middle Aged
  • Prognosis
  • Proteinuria
  • Statistics, Nonparametric
  • Treatment Outcome


  • Biomarkers
  • Creatinine