15th July 2024

Diagnosis and Classification

Any sign of renal involvement, e.g. reproducible proteinuria, haematuria or urinary casts should prompt referral for renal biopsy.  The majority of patients with SLE will demonstrate histological evidence of lupus nephritis on renal biopsy (even in the absence of symptoms). A biopsy is required for diagnosis with changes in the glomerulus allowing for classification into the stages below:

Class IV disease (diffuse proliferative glomerulonephritis) is the commonest and severest form of lupus nephritis. The renal biopsy will typically demonstrate glomeruli with endothelial and mesangial cellular proliferation.  If severe, a ‘wire-loop’ appearance and thickening of the capillary walls secondary to immune complex deposition may be seen (also noted on electron microscopy examination).