PATHIST WEB

The Home of High Resolution Light Microscopy (HRLM)
La Cuna de Microscopía Optica de Alta Resolución (MOAR)

DEPARTMENT OF PATHOLOGY
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
VETERANS AFFAIRS MEDICAL CENTER
NEW ORLEANS, LOUISIANA
 DIFFERENT APPROACH FOR THE MORPHOLOGIC STUDY OF THE GLOMERULOPATHIES.

 UNA MANERA DIFERENTE PARA ESTUDIAR LA MORFOLOGIA DE LAS GLOMERULOPATIAS.

SLE Chronic Complications (CC)
(WHO Sclerosing lesions)
Page SLE 4

LES Complicaciones Crónicas (CC)
(OMS Lesiones Esclerosantes)
Página LES 4
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Caja de Navegacion Local

Glomerulopathies Index

Back to Renal Pathology 2000

Indice Glomerulopatias

Volver a Patologia Renal 2000

SLE 1. Modified classification

SLE 2. Basic lesions

LES 1. Clasificación modificada

LES 2. Lesiones básicas

SLE 3. Active complications

SLE 4. Chronic complications

LES 3. Complicaciones activas

LES 4. Complicaciones crónicas

SLE 5. Pauci-immune nephropathies

SLE 6. Grading-Checklist a

LES 5. Nefropatía Pauci-inmune.

LES 6. Grado-Lista comprobación a

SLE 7. Grading-Checklist b

SLE 8. References

LES 7. Gradi-Lista comprobación b

SLE 8. Referencias.

See SLE 6 Check list a for gradding chronic complications.

Ver SLE 6 Lista comprobación a para graduación de complicaciones crónicas.

Grading Chronic Complications (CC): There are two paremeters to be considered when assessing a chronic complication: 1. modality: In the glomeruli, segmental or global. In the renal parenchima, patchy or uniform, and 2 extent (% of involvement). The "grade" of a chronic complication is not assessed since most of these lesions (if not all) are irreversible, most are scars and most produce abnormal function.

Graduando complicaciones cronicas (CC): Para graduar las lesiones superpuestas crónicas (complicaciones) se usan dos parámetros: 1. La modalidad (Segmentaria o global en los glomerulos y en parches o uniforme en el parénquima renal) y 2. Extensión (% de compromiso). El "grado" de una complicación crónica no se estima debido a que estas lesiones son generalmente irreversibles, la mayoría son cicatrices, y producen función anormal.

Chronic complications (WHO sclerosing lesions): MPGN, glomerular fibrosis and/or glomerular sclerosis, fibrous crescents, interstitial chronic inflammation, tubular atrophy, intesrtitial fibrosis, arteriolar sclerosis, arterio sclerosis.
All forms of glomerulonephritis may end up with diffuse sclerosis, a chronic complication (WHO sclerosing lesion) and not a different class of SLE (WHO class VI). Grade III more frequently and faster than grade I.

Non-SLE morphologic patterns superimposed may be also graded and staged by the same parameters.

Example: SLE PPGN basic grade I (mesangial deposits) with mild acute complications (mesangial proliferation) involving >50% of glomeruli. Mild but diffuse interstitial fibrosis. There are no extra SLE superimposed lesions (SLE PPGN I, AC1 >50%, CC1 >25%, XSLE 0)

Complicaciones cronicas (OMS lesiones esclerosantes): GNMP, Esclerosis o fibrosis glomerular, semilunas fibrosas, inflamacion intersticial cronica, atrofia tubular, fibrosis intersticial, esclerosis arteriolar, esclerosis arterial.
Todas las formas de glomerulonefritis puede terminar con fibrosis y esclerosis difusas, una complicacion cronica y no una clase diferente de LES (OMS clase VI). Con mayor frecuencia y rapidez los grados altos que los bajos.

  La superposición de otras nefropatías extra LES deben también evaluarse e incluir su descripción en el infrome de Patología.

Ejemplo: LES PPGN grado básico I (depósitos mesangiales) con complicación aguda leve (proliferación mesangial) compromete > 50% glomerulos. Fibrosis intersticial difusa leve. No hay complicaciones extra LES (LES PPGN I, AC1 >50%, CC2 <25%, XLES0)

Fig. 31. PPGN grade III with fibroepithelial crescent

Fig. 32. PPGN grade III with fibous crescent (Activity grade 2. Chroniciy stage 2)

Fig. 33. MXGN grade III with fibous crescents and interstitial nephritis (Activity grade 2. Chroncity grade 2.

Fig. 34. PPGN grade III with interstitial fibrosis and tubular atrophy (Activity grade 2. Chronicity stage 3).

Fig. 35. PPGN grade I with FSGS (Red arrows) (Activity grade 1. Chronicity stage 2).

Fig. 36. PPGN grade III with FSGS (Red arrows).

Fig 43. SLE vasculopathy (Red arrows), No GN. (The grade of the lesions is 3. The stage is 1).

Fig. 44. SLE thrombotic microangiopathy (1. Thrombus. 2.Endothelial cells. 3. Subendothelial fibrosis. 4. Lamina elastica. 5. Muscularis). No GN. (The grade of the lesion is 3)

Fig. 37. MBGN (SLE) grade II with superimposed diabetic nephropathy (1. Hypercellular nodules. 2. Capsular hyalinosis). DM has low activity (grade 1) and moderate chronicity (stage 2).

Fig. 38. MBGN (SLE) grade I with superimposed diabetic nephropathy (1. Subepithelial deposits. 2. Thick GBM. 3. C. of Bowman). DM has low activity (grade 1) and moderate chronicity stage 2).

Fig# 39. SLE MBGN and Diabetic nephropathy.