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ISRN Immunology
Volume 2011 (2011), Article ID 502578, 5 pages
Clinical Study

Clinical and Morphologic Differences between Class IV-S and Class IV-G Lupus Nephritis

1Department of Internal Diseases, Clinic of Internal Diseases and Therapy, Medical Institute Ministry of Interior, 1504 Sofia, Bulgaria
2Department of Rheumatology, Medical University Sofia, 1606 Sofia, Bulgaria
3Department of Pathoanathomy, Medical University Sofia, 1606 Sofia, Bulgaria

Received 27 April 2011; Accepted 22 May 2011

Academic Editor: A. Tommasini

Copyright © 2011 Daniela Monova et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. The new ISN/RPS classification of lupus nephritis (LN) divides diffuse proliferative LN into two subcategories with predominantly segmental proliferative lesions (class IV-S) and with predominantly global proliferative lesions (class IV-G). This paper explores the validity of this distinction and possible differences between the two types of lesions. Patients and Methods. A retrospective analysis of biopsy-proven cohort of 231 patients with LN was performed. Clinical and laboratory data were available on all patients selected. Results. The prevalence of Class IV was 27,27% (41 patients had class IV-S, 22-class IV-G). The serum creatinine levels, proteinuria, and diastolic blood pressure were significantly greater in the IV-G class, but haemoglobin was significantly lower. Histologically combined lesions with segmental endocapillary proliferation and fibrinoid necrosis were more frequent in the class IV-S. No significant difference was detected in outcomes in the two groups after followups of 145,2 ± 76,87 months. Conclusions. There are definite clinical and morphologic differences between class IV-S and IV-G lesions. Data suggest that class IV-G lesions behave as an immune complex disease; however, in class IV-S lesions, the presence of proportionally greater glomerular fibrinoid necroses suggests that these lesions may have a different pathogenesis.