Renal Diseases in Systemic Diseases

　
A

Lupus Nephritis
B

Diabetic Nephropathy

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A. Lupus Nephritis

Classification:

Class I

Normal glomeruli (by LM, IF, EM)

Class II

Pure mesangial alterations

  1. Normal by LM, mesangial deposits by IF and/or EM
  2. Mesangial hypertrophy and deposits by IF and/or EM

Class III

Focal segmental glomerulonephritis

  1. Active necrotizing lesions
  2. Active and sclerosing lesions
  3. Sclerosing lesions

Class IV

Diffuse glomerulonephritis (severe mesangial, endocapillary or mesangiocapillary proliferation, and/or extensive subendothelial deposits)

  1. Without segmental lesions
  2. With active necrotizing lesions
  3. With active and sclerosing lesions
  4. c. With sclerosing lesions

Class V

Membranous glomerulonephritis

  1. Pure membranous glomerulonephritis
  2. Associated with lesions of Class II (a or b)
  3. Associated with lesions of Class III (a, b, or c)
  4. d. Associated with lesions of Class IV (a, b, c, or d)

Class VI

Advanced sclerosing glomerulonephritis

Characteristic lesions

  1. Wire-loop lesion = massive subendothelial immune deposits
  2. Hyaline thrombi = large intracapillary immune deposits
  3. Fibrinoid degeneration or necrosis = intimal immune and fibrin deposits
  • Hematoxyline bodies = tissue LE cells by anti-nuclear antibodies ( anti-DNA antibody, anti-RNA antibody, anti-histone antibody.)
  • Fingerprint subtructure, tubuloreticular inclusions

　

Activity and Chronicity

Activity

Chronicity

Endocapillary hypercellularity
Leukocyte infiltration
Subendothelial hyaline deposits
Cellular crescent
Interstitial inflammation

Glomerular sclerosis
Fibrous crescent
Tubular atrophy
Interstitial fibrosis

LM: diffuse glomerulonephritis


IF

EM: WIre-loop Lesion=subendothelial deposits

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B. Diabetic Nephropathy

Clinical classification

Stage

Proteinuria

Glemerular filtration

Pathology

I

normal

normal - hyperfiltration

normal - mild diffuse lesion

II

microalbuminuria

normal - hyperfiltration

normal - moderate diffuse lesion
with occasional nodular lesion

IIIA

persistent

normal

moderate diffuse lesion
with frequent nodular lesion

IIIB

persistent (1g>=day)

low (<=60 ml/min)

severe diffuse lesion
with frequent nodular lesion

IV

persistent

very low

end-stage kidney

V

Hemodialysis

Characteristic lesions

1) Diffuse lesion

Increase of mesangial matrix
Thickening of GBM

2) Nodular lesion (Kimmelstiel-Wilson lesion)
3) Exudative or hyalinosis lesion

Fibrin cap
Capsular drop
Hyaline degeneration or necrosis of arterioles

LM (HE): Diffuse lesion
EM: GBM thickening

Progression to Nodular Lesion
(HE)

　


Lamination of Nodule
(PAM)
Fibrin cap
(HE)

Capsular drop
(HE)

Hyaline degeneration of
afferent and efferent arterioles

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