Diffuse lupus glomerulonephritis

Diffuse lupus glomerulonephritis, ISN / RPS 2003 the most controversial amendments to the classification of type Ⅳ LGN, the subtype classification in order to facilitate the study of the pathogenesis, clinical and prognostic parameters. A large number of studies have shown that there are differences, IV S-type LGN Ⅳ G-type LGN prognosis, which may be different in the pathogenesis of various genotyping. In the evaluation of severity, activity and sclerosis lesions have to be taken into account.
Type Ⅳ LGN light microscopy showed thickening of the glomerular capillary wall showed diffuse, platinum ear disease, platinum ear refers to the deposition of immune complexes in the subendothelial capillary wall stiffness, and the occurrence of the refractive index. Transparent thrombosis and capillary wall double-track sign. Other histologic variants include a wide range of subendothelial deposits, capillaries filled with ball inside and outside hyperplasia, inflammatory cell infiltration with mild or moderate immune deposits and glomerular mesangial matrix and mesangial cells hyperplasia. These lesions show the heterogeneity of the vascular lesions of the ball in the LGN. The immunofluorescence visible immune deposits "sold out" phenomenon, namely, the deposition of IgG, but also shows the IgM, IgA and complement composition C3, c4, C1q deposition. Electron microscopy showed that in the mesangial area, the skin, visible in the basement membrane immune complex deposition, visible chunk of subendothelial electron dense. Type Ⅳ LGN observed ultrastructure, such as 5% to 10% of patients in the electron microscope similar cryoglobulinemia "fingerprint-like structures, arranged in parallel by the diameter of 10-15 tim micro-fiber curve composed of . These finger-like structure has not been accompanied by cryoglobulinemia, and more easily observed in the vascular basement membrane can be seen in the tubules and blood vessels surrounding the basement membrane and micro-arterial wall. The majority of patients with positive antibodies and hypocomplementemia. Tubulointerstitial most serious in the III, Ⅳ type, biopsy (particularly long course of patients) suggestive of interstitial lesions, including cell number and the amount of interstitial Tubular interstitial involvement and important sign of a prognosis. Visible in a small number of type IV LGN vascular injury, the performance of vascular immune deposits, lupus vasculopathy accompanied by a large number of non-inflammatory small artery and arteriole endothelial deposits, thrombotic microangiopathy, and occasionally necrotic arteritis.