Renal glomerular lesions in systemic lupus erythematosus

Abstract

Of the 53 cases with proven SLE, 48 were females aged 23.9 ± 9.5 yr (SD); 44 of them were Chinese. The most common clinical presentations were a malar type rash, nephrotic syndrome and low grade pyrexia. LE cells were positive in 83.0% of the cases. On light microscopy the glomerular lesions were found to belong to 5 main groups: diffuse proliferative GN (56.6%), membranoproliferative GN (24.5%), focal proliferative GN (11.3%), no obvious lesion (5.6%) and membranous GN in only one case. Epithelial cresents and focal glomerular tuft necrosis were seen in the cases with proliferative lesions. Haematoxylin bodies were seen in only 3 cases (< 5%). With immunofluorescent antibody studies, all cases showed maximal deposition of IgG with 80.0% showing a combination with other immunoglobulins. The glomerular pathology was mediated through the complement pathway utilizing C3 and C1q. Only the most severe cases with marked morphological changes and heavy immunoglobulin deposits showed positive fluorescence against transferrin and HBAg. It was possible to subclassify morphologically lupus nephritis according to light and electron microscopy and immunofluorescent antibody techniques. These patterns of glomerular pathology were graded. There was a good correlation between the pathological findings on light and electron microscopy and immunofluorescent antibody techniques.