Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices

Ingeborg M. Bajema, Suzanne Wilhelmus, Charles E. Alpers, Jan A. Bruijn, Robert B. Colvin, H. Terence Cook, Vivette D. D'Agati, Franco Ferrario, Mark Haas, J. Charles Jennette, Kensuke Joh, Cynthia C. Nast, Laure Hélène Noël, Emilie C. Rijnink, Ian S.D. Roberts, Surya V. Seshan, Sanjeev Sethi, Agnes B. Fogo

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

We present a consensus report pertaining to the improved clarity of definitions and classification of glomerular lesions in lupus nephritis that derived from a meeting of 18 members of an international nephropathology working group in Leiden, Netherlands, in 2016. Here we report detailed recommendations on issues for which we can propose adjustments based on existing evidence and current consensus opinion (phase 1). New definitions are provided for mesangial hypercellularity and for cellular, fibrocellular, and fibrous crescents. The term “endocapillary proliferation” is eliminated and the definition of endocapillary hypercellularity considered in some detail. We also eliminate the class IV-S and IV-G subdivisions of class IV lupus nephritis. The active and chronic designations for class III/IV lesions are replaced by a proposal for activity and chronicity indices that should be applied to all classes. In the activity index, we include fibrinoid necrosis as a specific descriptor. We also make recommendations on issues for which there are limited data at present and that can best be addressed in future studies (phase 2). We propose to proceed to these investigations, with clinicopathologic studies and tests of interobserver reproducibility to evaluate the applications of the proposed definitions and to classify lupus nephritis lesions.

Original languageEnglish (US)
Pages (from-to)789-796
Number of pages8
JournalKidney international
Volume93
Issue number4
DOIs
StatePublished - Apr 2018

Keywords

  • lupus nephritis
  • renal biopsy
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Nephrology

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    Bajema, I. M., Wilhelmus, S., Alpers, C. E., Bruijn, J. A., Colvin, R. B., Cook, H. T., D'Agati, V. D., Ferrario, F., Haas, M., Jennette, J. C., Joh, K., Nast, C. C., Noël, L. H., Rijnink, E. C., Roberts, I. S. D., Seshan, S. V., Sethi, S., & Fogo, A. B. (2018). Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney international, 93(4), 789-796. https://doi.org/10.1016/j.kint.2017.11.023