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Histopathologic Features of Class IV Lupus Nephritis

Image 1 of 4 in Series "Histopathologic Features of Class IV Lupus Nephritis"

Description

Extracapillary crescentic glomerulonephritis is seen in a variety of disease states, including lupus. This process is mediated by immune complex deposition and proliferating epithelial cells. The lesions in this image are segmental and make up > 50% of the glomeruli in the biopsy. Crescent formation here is described as extra-capillary cellular proliferation partially filling Bowman's space and is indicative of severe glomerular disease and active lupus.

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This image is part of the series "Histopathologic Features of Class IV Lupus Nephritis"

Other images in this series

Histopathologic Features of Class IV Lupus Nephritis

by: John T. Herion, DO; Barry R. Gorlitsky, MD

Hypercellular glomerulus with hyaline thrombi (1) and markedly thickened capillary loops, commonly referred to as "wire loop" lesions (2). The hypercellularity of the glomerulus is indicative of inflammatory cell infiltration and mesangial proliferation. Hyaline thrombi and "wire loop" lesions are caused by intracapillary and subendothelial immune complex deposition respectively.

Histopathologic Features of Class IV Lupus Nephritis

by: John T. Herion, DO; Barry R. Gorlitsky, MD

This image depicts the "full-house" staining seen on immunofluorescent staining, a feature most frequently associated with lupus nephritis. Immunostaining for IgG, IgM, IgA, C3, and C1q are all positive. In class IV lupus nephritis these immune complexes are deposited in both the subendothelium, subepithelium, and mesangium resulting in globally intense staining.

Histopathologic Features of Class IV Lupus Nephritis

by: John T. Herion, DO; Barry R. Gorlitsky, MD

Electronmicroscopy of the glomerulus demonstrating electron dense deposits of varying size and shape in the mesangium (black arrow), subepithelium (red arrow) and subendothelium (blue arrow). The distribution of the immune complex deposits mirrors that seen on immunofluorescence.