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Park, Kwak, Jung, Koh, Kim, and Suh: Transformation of Recurred Lupus Nephritis from Class IV to Class V
Case Report
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(5): 290-294.

Published online: 31 October 2012

DOI: https://doi.org/10.4078/jrd.2012.19.5.290

Transformation of Recurred Lupus Nephritis from Class IV to Class V

Jin-Ju Park, Ji-Yeong Kwak, Ju-Yang Jung, Bo-Ram Koh, Hyoun-Ah Kim, Chang-Hee Suh

Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea.

Corresponding to: Chang-Hee Suh, Department of Rheumatology, Ajou University School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, Korea. chsuh@ajou.ac.kr

Received 5 October 2011       Revised 23 October 2011       Accepted 26 October 2011

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There are numerous studies about the transformation of renal pathology during lupus nephritis progression. A number of researchers suggest that patients with previous proliferative glomerulonephritis may not need to repeat renal biopsy in relation to treatment strategies. However, the pathology of renal biopsy could offer important information to clinicians about the progression of disease. Here, we report a rare case of the convertion of ISN/RPS classification from a proliferative lesion to a wholly non-proliferative lesion. A 40-year-old female was admitted complaining of generalized edema for 1 month. At the age of 33 she had been diagnosed as SLE with proliferative lupus nephritis. The renal remission was induced with corticosteroid pulse therapy and 12 cycles of intravenous cyclophosphamide treatment. The repeated renal biopsy revealed class V lupus nephritis compared with referential biopsy of class IV-G. A better prognosis is expected with lower activity and a lower chronicity index. Repeat renal biopsy may give useful information relating to the prognosis of nephritis.

Keywords: Lupus nephritis, Biopsy, Prognosis

Figures and Tables

Figure 1
Pathologic findings of renal biopsies. (A) First biopsy: The glomerulus shows marked hypercellularity due to mesangial and endocapillary proliferation, and inflammatory cell infiltration. Hyaline thrombi are clearly observed in capillary lumen (H&E, ×400). (B) First biopsy: Electron microscopy image shows electron dense deposits at mesangium and subendothelial layer. (C) Second biopsy: No significant mesangial matrix widening, mesangial cell proliferation and endocapillary wall thickness are shown (H&E, ×400). (D) Second biopsy: Electron dense deposits are observed at mesangium and subepithelial locations along the glomerular basement membranes by electron microscopy.
jrd-19-290-g001
Figure 2
Changes of proteinuria according to treatment with cyclophosphamide and mycophenolate mofetil. The renal rebiopsy was performed and proteinuria was improved significantly after 3 cycles of cyclophosphamide and mycophenolate mofetil administration. CYP: cyclophosphamide, MMF: mycophenolate mofetil.
jrd-19-290-g002

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