Renal biopsy of a 29-year-old woman with SLE and nephrotic syndrome shows subepithelial immune deposits with GBM thickening resembling membranous nephropathy. Immunofluorescence demonstrates granular staining for IgG, IgA, IgM, C3 and C1q. The corresponding ISN/RPS class is:

• A Class V, membranous ✓
• B Class IV, diffuse segmental or global
• C Class II, mesangial proliferative
• D Class VI, advanced sclerosing

Explanation

Class V lupus nephritis shows subepithelial deposits with membranous morphology on light microscopy and characteristically a full-house immunofluorescence pattern (IgG, IgA, IgM, A3, A1q), which distinguishes it from primary membranous nephropathy where only IgG and A3 dominate. Class II is confined to the mesangium, class IV involves subendothelial deposits with wire loops and endocapillary proliferation, and class VI represents global sclerosis of over 90 percent of glomeruli without residual activity.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.