Role of renal biopsy in evaluation of morphological spectrum and pathogenesis of lupus nephritis

Introduction: Lupus nephritis is a common complication in patients with systemic lupus erythematous (SLE) characterized by deposition of antibodies in glomerular, vascular and tubulointerstitial compartments of the kidney. International society of Nephrology/ Renal Pathology Society (ISN/RPS) 2003 classification plays an important role in the diagnosis and predicting prognosis in these cases. The aim of this study was to evaluate the morphological changes in renal biopsy and to correlate them with the pathogenesis of lupus nephritis. Methods: This was a cross sectional study of 50 renal biopsies of lupus nephritis from two tertiary care centers. Clinical data, lab findings, histopathology slides and immunofluorescence findings were retrieved and analysed by two senior pathologists. The activity and chronicity indices were calculated by each pathologist and were compared for inter observer variation. The activity index was correlated with immunofluorescence findings. Results: The mean age of patient was 29.75 years with M:F ratio of 1:9.The frequency of each class according to ISN/RPS classification was class I (0%),class II (20%),class III (2%),class IV (62%),class V (14%) and class VI (2%). All class IV cases were global and active with maximum activity indices. The mean of activity and chronicity indices of pathologist A was 8.83, 2.7 and pathologist B was 9.13, 1.9. High activity showed increased intensity (3+) of IgG  and C3 staining on immunofluorescence. Conclusion: We found that activity and chronicity indices calculated on renal biopsy along with immunofluorescence findings can suggest the extent of pathogenesis of lupus nephritis. This can be useful for further management and follow up. DOI: 10.21276/APALM.1562