• Raouf Rahim Mirza Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.




Systemic lupus erythematosis, Lupus nephritis, Histopathological classification



Lupus nephritis is one of the most serious manifestations of Systemic lupus erythematosis and it is a major cause of morbidity and mortality. 


To find out the relation between Histopathologyical classes of Lupus nephritis with renal, extra renal clinical manifestation and laboratory data. 

Patients and Methods

A cross-sectional study performed on 45 patients with biopsy proven lupus nephritis, which they were collected from April 2012 to April 2013. 


The current study shows female predominance 32 (71.1%) compared with 13 (28.9%) male. Class IV 15 (33.3%) was the most common type followed by class III 9 (20.9%). The new onset hypertension was the commonest clinical renal presentation 32 (71.1%) and the musculoskeletal manifestation 37 (82.2%) was the most common extra renal manifestation. The correlation between classes of Lupus nephritis with clinical and laboratory data were significant for hypertension, 24 hrs urinary protein excretion, S. Creatinine, S. Albumin, Anti-Sm and Anti-dsDNA positivity and low complement levels (C3, C4).


Class IV is the commonest class of Lupus nephritis. Female preponderance becomes less pronounce in lupus nephritis compared to prevalence SLE.


Mok CC, Lau CS. Pathogenesis of systemic lupus erythematosus. J Clin Pathol. 2003 ; 56:481–490. DOI: https://doi.org/10.1136/jcp.56.7.481

Oliver JE, Silman AJ. Why are women predisposed to autoimmune rheumatic diseases? Arthritis Res Ther. 2009;11:252. DOI: https://doi.org/10.1186/ar2825

Vanholder R, De Keyser F, Kips J, et al. The pathophysiology of lupus erythematosus. European journal of dermatology : EJD. 1998; 8:4–7.

Stuart L, Hughes J: Apoptosis and autoimmunity. Nephrol Dial Transpl. 2002; 17:697–700. DOI: https://doi.org/10.1093/ndt/17.5.697

Berden Jh: Lupus nephritis. Kidney Int . 1997;52:538–558. DOI: https://doi.org/10.1038/ki.1997.365

Mok CC. Prognostic factors in lupus nephritis. Lupus. 2005;14:39–44. DOI: https://doi.org/10.1191/0961203305lu2057oa

Golbus J, McCune WJ: Lupus nephritis: classification, prognosis, immunopathogenesis, and treatment. Rheum Dis Clin North Am 1994; 20:213- 242. DOI: https://doi.org/10.1016/S0889-857X(21)00232-5

Boumpas DT, Austin HA, Fessler BJ, et al. Systemic lupus erythematousus: emerging concepts. I. Renal, neurospychatric, cardiovascular, pulmonary, and hematologic disease. Ann Intern Med 1995; 122:940-950. DOI: https://doi.org/10.7326/0003-4819-122-12-199506150-00009

Andrew S. Bomback and Gerald B. Appel, Updates on the Treatment of Lupus Nephritis; J Am Soc Nephrol 21: 2028–2035, 2010. doi: 10.1681/ASN.2010050472 DOI: https://doi.org/10.1681/ASN.2010050472

Appel GB, Radhakrishnan J, D’Agati V: Secondary glomerular diseases.Brenner B, ed. The Kidney, Philadelphia: Saunders Elsevier; 2008:1067-1147.

Jacobsen S, Petersen J, Ullman S, et al. A multicenter study of systemic lupus erythematousus in 513 Danish patients. II Mortality and factors of prognostic value Clin Rheumatol 1998; 17:478-84. DOI: https://doi.org/10.1007/BF01451283

Jacobsen S, Petersen J, Ullman S, et al. Mortality and cause of death of 513 Danish patients with systemic lupus erythematousus. Scand. J Rheumatol 1999; 28:75-80. DOI: https://doi.org/10.1080/030097499442522

Zahra Mirfeizi, Mahmoud Mahmoudi , Masih Naghibi et al. Urine Monocyte Chemoattractant Protein-1(UMCP-1) as a Biomarker of Renal Involvement in Systemic Lupus Erythematosus, Iranian Journal of Basic Medical Sciences Vol. 15, No. 5, Sep-Oct 2012, 1191-1195.

Khader N. Mustafa ,Tariq N. Aladily,Maha S. Shomaf et al ;Renal Biopsy Findings in Lupus Nephritis ,Saudi J Kidney Dis Transpl 2011;22(4):815-817.

Luo Ping Lu Shan Lu, Xuehong Luoman Yu. 60 cases of lupus nephritis clinical and pathological analysis, CLC 2008: R593.242.

Mumtaz Patel, Alexandra M. Clarke, Ian N. Bruce et al, The Prevalence And Incidence Of Biopsy-Proven Lupus Nephritis In The Uk Arthritis & Rheumatism Vol. 54, No. 9, September 2006, 2963–2969. DOI: https://doi.org/10.1002/art.22079

Ana Karla Guedes de Melo, Alessandra Barbosa Avelar ,Flávia Kamy Marciel Maegawa et al; Analysis of 100 patients with lupus nephritis followed up for 2 years, Rev Bras Reumatol, 2009;49(1):8-19. DOI: https://doi.org/10.1590/S0482-50042009000100002

Huong DLT, Papo T, Beaufil H, et al. Renal involvement in systematic lupus erythematosus. A study of 180 patients from a single center. Medicine (Baltimore) 1999;78:148-66. DOI: https://doi.org/10.1097/00005792-199905000-00002

Derksen RH, Hene RJ, Kater L. The long-term clinical outcome of 56 patients with biopsy-proven lupus nephritis followed at a single center. Lupus 1992;1:97-103. DOI: https://doi.org/10.1177/096120339200100207

Seedat YK, Parag KG, Ramsaroop R. Systematic lupus Erythematosus and renal involvement. A South Africa experience. Nephron 1994;66:426-30. DOI: https://doi.org/10.1159/000187858

Shayakul C, Parichatikanond P, Ongayooth L, et al. Lupus nephritis in Thailand: clinicopathologic findings and outcome in 569 patients. Am J Kidney Dis 1995;26:300-07. DOI: https://doi.org/10.1016/0272-6386(95)90650-9

Chu SJ, Chang DM, Kuo SY, et al. Lupus nephritis:an analysis of 70 cases. Zhonghua Yi Xue Za Zhi (Taipepi). 1994;53:27-36.

Al-Jarallah K, Al-Awadi A, Siddiqui M, et al. Systemetic lupus erythematosus in Kuwait hospital based study. Lupus 1998; 7: 434-438. DOI: https://doi.org/10.1191/096120398678920389

Al-Attia HM, Al Ahmed YH, Chandani AU. Serological markers in Arabs with lupus nephritis. Lupus Nephritis. Lupus 1998;7:198-201. DOI: https://doi.org/10.1191/096120398678920000

Hamdy Sliem1, Gamal Tawfik1, Khalil A Khalil1 et al, Pattern of systemic lupus erythematosus in Egyptian patients: the impact of disease activity on the quality of life, Pan African Medical Journal. 2011; 6:14. DOI: https://doi.org/10.4314/pamj.v6i1.69084

Niang A, Ka EF, Dia D , et al. lupus nephritis in Senegal ; a study of 42 cases, Saudi J Kidney Dis Transpl 2008;19(3):470-474.

Varun Dhir, Amita Aggarwal, Able Lawrence et al, Long-Term Outcome of Lupus Nephritis in Asian Indians, Arthritis Care & Research 2012; Vol. 64, No. 5, pp 713–720. DOI: https://doi.org/10.1002/acr.21597

Preetha A, S.D. Tarey, Girija Singh. Renal Manifestations In Patients With Systemic Lupus Erythematosus, St. John’s Medical College & Hospital, Bangalore 2006; 560 034.

Carlos Franco, Wonsuk Yoo, Domingo Franco, Predictors of End Stage Renal Disease in African Americans with Lupus Nephritis, Bulletin of the NYU Hospital for Joint Diseases 2010;68(4):251-6.

Indiran P Naiker, Vivien Chrystal, Ismail GH Randeree, et al.The significance of arterial hypertension at the onset of clinical lupus nephritis, Postgrad Med J 1997; 73: 230-233. DOI: https://doi.org/10.1136/pgmj.73.858.230

Stewart J. Cameron, Lupus Nephritis ,Renal Unit, Guy’s and St. Thomas’ Hospitals, King’s College, London, United Kingdom, J Am Soc Nephrol 1999; 10: 413–424 . DOI: https://doi.org/10.1681/ASN.V102413

Simin Torabi Nezhad, Roushak Sepaskhah. Correlation of clinical and pathological finding in patients with lupus nephritis, Saudi J Kidney Dis Transpl 2008;19(1):32-40.

Hitoshi Yokoyama, Takashiwada, Akinori Hara et al, The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese, Kidney International 2004; 66: 2382–2388. DOI: https://doi.org/10.1111/j.1523-1755.2004.66027.x

Jim LC Yong, Murray C Killingsworth, Ken Lai. Renal biopsy pathology in a cohort of patients from southwest Sydney with clinically diagnosed systemic lupus erythematosis, International Journal of Nephrology and Renovascular Disease 2013;6:15-26. DOI: https://doi.org/10.2147/IJNRD.S34357

Surya V. Seshan, J. Charles Jennette, Renal Disease in Systemic Lupus Erythematosus With Emphasis on Classification of Lupus Glomerulonephritis Advances and Implications, Arch Pathol Lab Med. 2009;133:233–248). DOI: https://doi.org/10.5858/133.2.233

Parichatikanond P, Nd Francis, P Malasit. Lupus nephritis: clinicopathological study of 162 cases in Thailand , J Clin Pathol 1986;39:160-166 . DOI: https://doi.org/10.1136/jcp.39.2.160

WANG Guo-bao, XU Zheng-jin, LIU Hong-fa et al, Changes in pathological pattern and treatment regimens based on repeat renal biopsy in lupus nephritis, Chin Med J 2012;125(16):2890-2894.

N. Hiramatsu, T. Kuroiwa, H. Ikeuchi. Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions, Rheumatology 2008;47:702–707. DOI: https://doi.org/10.1093/rheumatology/ken019

Laena Onga Jyooth, Chairat Shayakul, Palsal Parlchatikanond et al. Lupus Nephritis in Males: 8-Year Experience at Siriraj Hospital, Asian Pacific Journal of Allergy and Immunology 1994;12:87-93.

Habib Emre, Yasemin Usul Soyoral, Hüseyin Beğenik et al, Analysis of Patients With Lupus Nephritis: A Single Center’s Experience Van Tıp Dergisi 2011;18(2):101-105.

McHardy KC, Horne C, Rennie J. Antinuclear antibody-negative SLE: how common? J Clin Pathol. 1982;35:1118–1121. DOI: https://doi.org/10.1136/jcp.35.10.1118

Reichlin M. ANA negative systemic erythematosus sera revisited serologically. Lupus. 2000;9:116–19. DOI: https://doi.org/10.1191/096120300678828091

Kavanaugh A, Tomar R, Reveille J et al. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Arch Pathol Lab Med. 2000;124:71–81. DOI: https://doi.org/10.5858/2000-124-0071-GFCUOT

Uthman IW, Muffarij AA, Mudawar WA et al. Lupus nephritis in Lebanon, Lupus 2001;10:378-81. DOI: https://doi.org/10.1191/096120301670808045

G Moroni, A Radice, G Giammarresi et al; Are laboratory tests useful for monitoring the activity of lupus nephritis? A 6-year prospective study in a cohort of 228 patients with lupus nephritis ,Ann Rheum Dis 2009;68:234–237. DOI: https://doi.org/10.1136/ard.2008.094508

Drakoulogkona Ourania, Rîcă Ioana, Bărbulescu Andreea. Immunological Profile in Patients with Lupus Nephritis and Correlations with the Histological Pattern, Current Health Sciences Journal. 2011;37(4)161-4

P Alba, L Bento, M J Cuadrado et al, Anti-dsDNA, anti-Sm antibodies, and the lupus anticoagulant: significant factors associated with lupus nephritis, Ann Rheum Dis 2003;62:556–560. DOI: https://doi.org/10.1136/ard.62.6.556

Anthony S. Fauci, Carol A. Langford, Dennis L. Kasper et al, Harrison's Rheumatology (2nd Ed); P(68).



How to Cite

Mirza R. HISTOPATHOLOGICAL CORRELATION OF LUPUS NEPHRITIS WITH EXTRA-RENAL MANIFESTATION AND LABORATORY FINDINGS. JSMC [Internet]. 2017 Aug. 15 [cited 2024 Jul. 22];7(2):169-77. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10118

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