ANSWER: C The patient has a Diffuse Lupus Nephritis, Class IV-S (A). Although biopsy shows focal and segmental proliferative glomerulonephritis that could represent a Class III, the presence of diffuse wire loop (subendothelial) deposits warrants the designation of a Class IV.
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The ISN/RPS 2004 classification of lupus nephritis is entirely based on glomerular changes. Depending on the presence or absence of active and/or chronic glomerular lesions, cases are allocated into one (and occasionally two) of six possible classes. The most commonly encountered active glomerular lesions in clinical practice are in the form of endocapillary or extracapillary proliferation, fibrinoid necrosis or cellular crescents. However, deposition of large subendothelial immune deposits, even in the absence additional proliferative/necrotizing lesions is sufficient to classify a case as class III or IV, depending on the number of involved glomeruli (Fig 1-3). These deposits, termed “wire loops”,...
ANSWER: D Endocapillary hypercellularity, crescents, karyorrhexis and wire loops are some of the glomerular lesions seen in LN class III/IV