Skip to main content
Log in

Histopathology of Lupus Nephritis

  • Published:
Clinical Reviews in Allergy & Immunology Aims and scope Submit manuscript

Abstract

The spectrum of morphologic changes in lupus nephritis, either microscopic, ultrastructural, or immunohistological, closely reflects the great variety of immune complexes that are produced in the course of the disease. Every tissue component of the kidney can be affected, but glomeruli are the target structure in most patients. Several attempts have been made to correlate the clinical severity and the outcome of the nephritis with the pathologic features; the current classification and the six classes that resulted from an international study group are entirely based on glomerular changes. Major criteria of classification include the focal or diffuse involvement of the glomerulus, the site of hypercellularity, the site of immune complex deposition and the presence of active and/or sclerotic lesions. Even if less thoroughly investigated than the glomerulus, the interstitial compartment has revealed many interesting features as are vascular lesions, a common and often underestimated feature. Typing of subpopulation of lymphoid infiltrates supports the emerging evidence indicating that B cells are promoting autoimmunity in mechanisms other than autoAb secretion. Many aspects are still debated and/or poorly understood, such as the interpretation of the so-called “full house nephropathy” that closely mimic lupus nephritis in seronegative patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Klemperer P (1948) The pathogenesis of lupus erythematosus and allied conditions. Ann Intern Med 28:1–11

    PubMed  CAS  Google Scholar 

  2. Weening JJ, D’Agati VD, Schwartz MM et al (2004) The classification of glomerulonephritis in sistemic lupus etythematosus visite. Kidney Int 65:521–530

    Article  PubMed  Google Scholar 

  3. D’Agati V (2007) Renal diseases in systemic lupus erythematosus. In: Jennette JC, Olson JL, Schwartz M, Siva FG (ed) Pathology of the kidney, 6th edn. Lippincott Williams & Wilkins

  4. Mittal B, Rennke H, Singh AK (2005) The role of kidney biopsy in the management of lupus nephritis. Curr Opin Nephrol Hypertens 14:1–8

    Article  PubMed  Google Scholar 

  5. Schwartz M (2007) Pathology of lupus nephritis. Semin Nephrol 27:22–34

    Article  PubMed  CAS  Google Scholar 

  6. Muda AO, Feriozzi S, Rahimi S, Ancarani E, Faraggiana T (1999) Spatial arangement of subepithelial deposits in lupus and non lupus membranous nephropathy. Am J Kidney Dis 34:85–91

    Article  PubMed  CAS  Google Scholar 

  7. Schwartz MM1, Korbet SM, Katz RS3, Lewis EJ (2009) Evidence of concurrent immunopathological mechanisms determining the pathology of severe lupus nephritis. Lupus 18:149–158

  8. Pickering MC, Botto M (2010) Are anti-C1q antibodies different from other SLE autoantibodies? Nat Rev Rheumatol (in press)

  9. Klemperer P (1940) Wire loops lesions. Arch Intern Med 66:1005

    Google Scholar 

  10. Frese-Schaper M, Zbaeren J, Gugger M, Monestier M, Frese S (2010) Reversal of established lupus nephritis and prolonged survival of New Zealand black and New Zealand white mice treated with the topoisomerase I inhibitor irinotecan. J Immunol 184:2175–2182

    Article  PubMed  CAS  Google Scholar 

  11. Hill GS, Delahousse M, Nochy D, Bariéty J (2005) Class IV-S versus class IV-G lupus nephritis: clinical and morphologic differences suggesting different pathogenesis. Kidney Int 68:2288–2297

    Article  PubMed  Google Scholar 

  12. Austin HA, Muenz IR, Joyce KM, Antonovych TT, Ballow JE (1984) Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome. Kidney Int 25:689–695

    Article  PubMed  Google Scholar 

  13. Hill GS, Delahousse M, Nochy D (2000) A new morphologic index for the evaluation of renal biopsies in lupus nephritis. Kidney Int 58:1160–1173

    Article  PubMed  CAS  Google Scholar 

  14. Mittal B, Hurwitz S, Rennke H, Singh AK (2004) New subcategories of class IV lupus nephritis: are there clinical, histologic, and outcome differences? Am J Kidney Dis 44:1050–1059

    Article  PubMed  Google Scholar 

  15. Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J, Rohde RD (2000) Factors predictive of outcome in severe lupus nephritis. Lupus Nephritis Collaborative Study Group. Am J Kidney Dis 35:904–914

    Article  PubMed  CAS  Google Scholar 

  16. Nasr SH, D'Agati VD et al (2008) Necrotizing and crescentic lupus nephritis with antineutrophil cytoplasmic antibody seropositivity. Clin J Am Soc Nephrol 3:682–690

    Article  PubMed  CAS  Google Scholar 

  17. Sharman A, Furness P, Feehally J (2004) Distinguishing C1q nephropathy from lupus nephritis. Nephrol Dial Transplant 19:1420–1426

    Article  PubMed  CAS  Google Scholar 

  18. Jennette JC, Hipp CG (1985) C1q nephropathy: a distinct pathologic entity usually causing nephrotic syndrome. Am J Kidney Dis 6:103–110

    PubMed  CAS  Google Scholar 

  19. Chan OT, Madaio MP, Shlomchik MJ (1999) The central and multiple roles of B cells in lupus pathogenesis. Immunol Rev 169:107–121

    Article  PubMed  CAS  Google Scholar 

  20. Papadimitraki ED, Choulaki CH, Koutala E et al (2006) Expansion of toll-like receptor 9-expressing B cells in active systemic lupus erythematosus. Implications for the induction and maintenance of the autoimmune process. Arthritis Rheum 54:3601–3611

    Article  PubMed  CAS  Google Scholar 

  21. Hayakawa S, Nakabayashi K, Karube M et al (2006) Tubulointerstitial immune complex nephritis in a patient with systemic lupus erythematosus: role of peritubular capillaritis with immune complex deposits in the pathogenesis of the tubulointerstitial nephritis. Clin Exp Nephrol 10:146–151

    Article  PubMed  Google Scholar 

  22. Nochy D, Daugas E, Droz D et al (1999) The intrarenal vascular lesions associated with primary antiphospholipid syndrome. J Am Soc Nephrol 10:507–518

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tullio Faraggiana.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Giannakakis, K., Faraggiana, T. Histopathology of Lupus Nephritis. Clinic Rev Allerg Immunol 40, 170–180 (2011). https://doi.org/10.1007/s12016-010-8207-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12016-010-8207-1

Keywords

Navigation