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World J Stem Cells. Aug 26, 2025; 17(8): 104930
Published online Aug 26, 2025. doi: 10.4252/wjsc.v17.i8.104930
Table 1 Classifications, histopathology and therapeutic approaches for lupus nephritis
Classifications
Histopathology
Therapeutic approaches
Minimal mesangial LN (class I)Only mesangial immune deposits; no light microscopic abnormalitiesHydroxychloroquine. Low-level proteinuria-immunosuppressive treatment guided by extrarenal manifestations of SLE. Nephrotic syndrome-maintenance combination therapy with low-dose glucocorticoid and another immunosuppressive agent
Mesangial proliferative LN (class II)Mesangial hypercellularity or mesangial matrix expansion. A few isolated subepithelial or subendothelial deposits on IF or EM
Focal LN (class III)< 50% glomeruli affected. Active or inactive endocapillary or extracapillary glomerulonephritis, always segmental (< 50% glomerular tuft). Subendothelial deposits on EMHydroxychloroquine. Initial therapy-glucocorticoids plus MPAA/low-dose intravenous cyclophosphamide/belimumab and either MPAA or low-dose intravenous cyclophosphamide/MPAA and a CNI. Maintenance therapy-low-dose glucocorticoids plus MPAA
Diffuse LN (class IV)≥ 50% glomeruli affected. Endocapillary with or without extracapillary glomerulonephritis. Subendothelial deposits on EM
Lupus membranous nephropathy (class V)Diffuse thickening of the glomerular capillary wall. Mesangial involvement. Subepithelial immune depositsHydroxychloroquine. Low-level proteinuria-RAS blockade, immunosuppressive treatment guided by extrarenal manifestations of SLE. Nephrotic syndrome-RAS blockade, immunosuppressive treatment with glucocorticoid and one other agent
Advanced sclerosing LN (class VI)Global sclerosis in > 90% glomeruliGeneral management