**Acknowledgements**

*Lupus - Need to Know*

reviewed [1, 7, 8, 36, 37].

**8. Conclusions**

Biopsy Report

Renal biopsy

no deposits in the vessels.

dense deposits.

vessels.

ID: RPS, caucasian, female with 38 years-old

conjugates, 1 fixated in glutaraldehyde 2,5% sent to EM.

ISN/RPS classification: Class IV-G (A/C) NIH Activity and Chronicity Indices:

*Biopsy Report Interpretation of Lupus Nephritis*

with degenerative changes of tubules. The vessels are unremarkable.

Tubulointerstitial and vascular lesions correlated closely with clinical disease activity and renal outcome in many studies [14, 19–21]. It is necessary at least to

The classification of LN, especially classes IV-G and IV-S, and the activity and chronicity indexes have not shown a satisfactory correlation with the long-term outcome of the disease [1, 7, 8, 13]. After treatment induction and even during the maintenance phase, the inflammatory process may persist and go unnoticed clinically. Some authors recommend repeating the renal biopsy after treatment to better assess the response to treatment and predict the course of the disease [1, 7, 8, 29]. There is also a poor reproducibility among pathologists to apply these criteria that limits their application in practice [1, 36, 37]. It is a consensus that the classification of LN as well as the criteria of activity and chronicity of the disease should be

In conclusion, the precise identification of key glomerular, tubulointerstitial and vascular lesions remain incompletely understood in terms of pathogenesis and prognostic effect. The ISN/RPS classification improved the knowledge of different patterns of LN lesions, and validation studies have shown new emerging morphological data to be further investigated and included in the classification [8, 12, 35]. Most nephrologists find an assessment of activity and chronicity

History: Patient with erythema and scaling in the face, lymphocitopenia, anemia, proteinuria of

Light Microscopy: Renal biopsy showing the cortical with 30 glomeruli, all with large size and mesangioendothelial heavy hypercellularity and moderate exsudate of polymorphonuclear neutrophils; some peripheral capillary loops show bulky hyaline deposits obliterating capillary lumens (wire loops). In 6 glomeruli there are small segments fibrinoid necrosis, nuclear debris and fibrin deposits, with overlying small cellular crescents. Two glomeruli are globally sclerosed surrounded by tubular atrophy and mild interstitial fibrosis. There is also a heavy interstitial edema and inflammatory infiltrate of mononuclear cells

Immunofluorescence: Presence of diffuse granular deposits in the mesangium and capillary loops of IgG (3/3+), IgA (2/3+), IgM (1/3+), C1q (3/3+), C3 (2/3+), Fibrin (2/3+), κ and λ (2/3+). There were deposits in the tubular basement membrane and peritubular capillaries of IgG and C1q (2/3+). There were

Renal biopsy diagnosis: Lupus nephritis characterized by diffuse proliferative glomerulonephritis with 20% of segmental necrosis, 20% of cellular crescents and 6,6% of global glomerular sclerosis. Intense lymphomononuclear tubulointerstitial nephritis with focal tubular atrophy and interstitial fibrosis. Normal

Activity: subendothelial deposits 2+, glomerular hypercellularity 3+, exsudate of neutrophils 2+,

Chronicity: glomerular sclerosis 1+, tubular atrophy 1+, interstitial fibrosis 1+. Total =3

necrosis 2+, cellular crescents 2+, interstitial inflammatory infiltrate 3+. Total = 14

Electron microscopy: Presence of mesangial, subendothelial and tubular basement membrane electron-

Macroscopy: 3 fragments of renal biopsy measuring each 1cm long. One fragment fixated in Duboscq-Brazil was sent to LM, 1 frozen fragment was sent to IF using anti-IgG, IgA, IgM, C1q, C3, Fibrin, κ and λ

2g/24h, microhematuria, serum creatinine of 1,8 mg/dl. Anti-dsDNA>200 UI, ANA 1/1600.

mention these lesions in the diagnosis of the biopsy report.

**30**

**Box 1.**

We thank our professors, the Department of Pathology and the Botucatu Medical School for all the learning that allowed this work.
