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Related Experiment Video

Updated: Aug 13, 2025

Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice

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The lupus nephritis classification: lost in translation.

William L Whittier¹

¹Rush University Medical Center, Division of Nephrology, Chicago, Illinois, USA.

Current Opinion in Nephrology and Hypertension

|January 23, 2023

Summary

The ISN/RPS classification for lupus nephritis needs revision. It should focus on disease pathophysiology and injury patterns, not just extent, to guide targeted therapies.

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Area of Science:

Nephrology
Immunology
Pathology

Background:

The current International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification for lupus nephritis is evolving.
The existing classification has shifted from a pathophysiology-based system to one focused on disease extent and prognosis.
This shift inadequately addresses the diverse pathophysiologic processes underlying lupus nephritis.

Approach:

The current classification fails to differentiate underlying pathophysiologic mechanisms, hindering the development of targeted therapies.
A revised classification should incorporate immunofluorescence and electron microscopy to accurately define injury patterns.
The focus should shift from the extent of disease to the specific pattern of renal injury.

Key Points:

Lupus nephritis is driven by multiple distinct pathophysiologic processes.
The current ISN/RPS classification is insufficient for distinguishing these processes.
Immunofluorescence and electron microscopy are crucial for identifying the pattern of injury.

Conclusions:

Accurate classification of lupus nephritis requires a return to pathophysiology-based criteria.
The upcoming revision must include advanced microscopy techniques.
Prioritizing injury patterns over disease extent will enable the development of targeted treatments for lupus nephritis.