What Are the 6 Types of Lupus Nephritis?

Medically Reviewed on 6/7/2022

6 stages of lupus nephritis

lupus nephritis
Lupus nephritis is a kidney condition caused as a complication of systemic lupus erythematosus (SLE) or lupus.

Lupus nephritis is classified into six stages depending on the microscopic studies of the glomeruli.

Class I: Minimal mesangial lupus nephritis

The earliest and mildest form of glomerular involvement is minimal mesangial lupus nephritis (class I).

  • Diagnosis of minimal mesangial lupus nephritis is quite rare because people with this condition have a nearly normal urinalysis, little or minor proteinuria, and normal serum creatinine. As a result, biopsies are rarely conducted.
  • Patients with class I lupus nephritis have only mesangial immune deposits recognized by immunofluorescence alone or immunofluorescence and electron microscopy; light microscopic cannot pick any abnormalities.

Class II: Mesangial proliferative lupus nephritis

Mesangial proliferative lupus nephritis (class II) is characterized clinically by microscopic hematuria and proteinuria.

With class II lupus nephritis:

  • Light microscopy reveals mesangial hypercellularity (of any degree) or mesangial matrix enlargement.
  • Immunofluorescence or electron microscopy may reveal a few isolated subepithelial or subendothelial deposits.

The prognosis of mesangial proliferative lupus nephritis is good. Any specific treatment for this condition is not indicated unless more advanced illness develops or signs of serious illness show.

Class III: Focal lupus nephritis

People with class III lupus nephritis usually have hematuria (blood in the urine) and proteinuria (proteins in the urine), and some individuals may additionally have hypertension, lower glomerular filtration rate, and nephrotic syndrome.

Histologically, class III illness is characterized as:

  • Light microscopy affects less than half of the glomeruli. Although light microscopy shows that fewer than half of the glomeruli are damaged, immunofluorescence microscopy (for immunoglobulin G and C3 abnormal proteins) shows practically uniform involvement.
  • Endocapillary or extra capillary glomerulonephritis, whether active or dormant, is always segmental (involving less than 50 percent of the glomerular tuft). Immune deposits are often discovered using electron microscopy in the subendothelial region of the glomerular capillary wall and mesangium (supporting tissues containing blood vessels in kidneys).

Determining the prognosis in class III condition is difficult because of the inability to calculate the percentage of affected glomeruli.

Class IV: Diffuse lupus nephritis

Diffuse lupus nephritis is the most common histologic pattern and the most severe type of lupus nephritis. Hematuria, proteinuria, nephrotic syndrome, hypertension, and decreased glomerular filtration rate are seen in nearly all patients with active class IV illness. Affected individuals often have severe hypocomplementemia (specifically C3) and increased anti-dsDNA levels, particularly during active illness.

Histologically, characteristics of class IV lupus nephritis are:

  • Light microscopy shows more than half of the glomeruli are affected. Hypercellular, necrotizing lesions (areas of tissue death), could be observed in active illness. A significant deposition of abnormal proteins, such as immunoglobulins (particularly immunoglobulin G) and complement (particularly C3), causing thickening of the glomerular capillary wall, is seen on light microscopy. If fewer than 50 percent of the lymph nodes are affected, the illness is classified as focal lupus nephritis (class III).
  • Endocapillary glomerulonephritis with or without extra capillary glomerulonephritis is seen in the affected glomeruli. Mesangial anomalies could be seen. Subendothelial deposits are shown by electron microscopy at least during the active period. Class IV illness is defined by the presence of widespread wire loop deposits but little or no glomerular growth.

Class V: Lupus membranous nephropathy

Lupus membranous nephropathy affects 10 to 20 percent of lupus nephritis patients. Patients with class V lupus nephritis often have nephrotic syndrome symptoms, comparable to those seen in primary membranous nephropathy. Microscopic hematuria and hypertension may be present, and the creatinine content is generally normal or perhaps slightly raised.

Class V illness is identified by diffuse thickening of the glomerular capillary wall and subepithelial immune deposits on immunofluorescence or electron microscopy. Mesangial participation is possible.

  • Immunofluorescence or electron microscopy can reveal a few subendothelial deposits (abnormal proteins just under the innermost layer of glomeruli) in class V illness.
  • The presence of such deposits observed by light microscopy necessitates a combination diagnosis of classes III and V disease or classes IV and V disease.
  • The extra identification of class III or IV in this context is based on the dispersion of the deposits.

Class VI: Advanced sclerosis lupus nephritis

Advanced sclerosing glomerulonephritis is characterized by gradually progressing kidney failure, proteinuria, and generally, bland urine sediment. Class VI illness is distinguished by sclerosis (microscopic scarring) of more than 90 percent of the glomeruli. It indicates the advanced stage of chronic class III, IV, or V lupus nephritis and the healing of previous inflammatory damage. Active glomerulonephritis should be observed.

16 symptoms of lupus nephritis

Lupus nephritis is a kidney condition caused as a complication of systemic lupus erythematosus (SLE) or lupus. SLE is an autoimmune disease where immune cells attack and destroy healthy tissues. Lupus nephritis is a result of inflammation of the kidney, a complication of SLE. The autoantibodies attack nephrons of the kidneys and disrupt the filtration process.

As a result, the 16 common symptoms of lupus nephritis include:

  1. Hematuria (cola-colored urine)
  2. Pains
  3. Nausea and vomiting
  4. Fatigue
  5. Shortness of breath
  6. Fevers
  7. Chest pain
  8. Increased blood pressure
  9. Edema (accumulation of fluid in tissues and causes swelling)
  10. Mouth and nasal sores
  11. Raynaud’s disease (fingers and toes turn blue when exposed to cold temperatures)
  12. Butterfly rash on the face
  13. Persistent urinary tract infections
  14. Pain and swelling of joints
  15. Memory loss
  16. Confusion


Systemic Lupus Erythematosus Browse our medical image collection to see of photos of autoimmune, vascular, and other systemic conditions See Images

How is lupus nephritis diagnosed?

Diagnosing lupus nephritis can be difficult because symptoms vary with people and may be present during one examination and then disappear at the next. Additionally, several lupus drugs may produce symptoms that are like those of lupus nephritis.

A doctor will obtain medical history, examine physically, assess the symptoms, and order the following tests:

  • Radiological tests:
    • X-rays
    • An intravenous pyelogram and a sonogram are two tests that are typically performed before a kidney biopsy (that offers the final diagnosis).
      • A dye is injected into the body and collected in the kidneys during an intravenous pyelogram. An X-ray is performed, and the dye reveals the contour of the kidneys. A sonogram depicts the form and size of the kidney surfaces by using soundwaves transferred through the body and their echoes.
  • Blood tests: These tests are performed to determine if the kidneys are properly eliminating waste materials from the blood. A blood test can indicate if there is a reduced amount of protein in the blood and a loss of protein in the urine. The blood test can reveal if there are electrolyte imbalances in the blood. It can detect antibodies that are generally elevated in people with lupus nephritis.
  • Urine tests: A urinalysis is a basic and widely used test to determine if a person has lupus nephritis. A urinalysis will look for red and white blood cells in the urine and excessive levels of proteins.
  • Biopsy: A procedure where a sample of kidney tissue is taken for examination under a microscope. A biopsy is performed to confirm the diagnosis of lupus nephritis if blood and urine tests indicate it. A biopsy can help determine the extent and severity of the renal disease. A biopsy is often performed by putting a thin needle through the back skin and retrieving a tiny bit of the kidney.

What are the treatment options for lupus nephritis?

There is no cure for lupus nephritis. Early detection and timely treatment with immunosuppressants, chemotherapy, and corticosteroids will suppress the immune system and slow down the progression of the illness.

Hemodialysis may be done to help remove all the toxins. However, it is a temporary solution. Some people do undergo various sessions of hemodialysis to keep their blood clean.

A kidney transplant remains the last resort for a person with lupus nephritis.

Medically Reviewed on 6/7/2022
Image Source: iStock image

Brent LH. Lupus Nephritis. Medscape. https://emedicine.medscape.com/article/330369-overview#a1

Brent LH. Lupus Nephritis Treatment & Management. Medscape. https://emedicine.medscape.com/article/330369-treatment#d10

eMedicineHealth. What Are the Six Classes of Lupus Nephritis? https://www.emedicinehealth.com/what_are_the_six_classes_of_lupus_nephritis/article_em.htm