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Lupus nephritis Diagnosis and classification

ClassPathologyPresentationTreatment (all benefit from HCQ)
IMin. mesangialNormal U/A & eGFRNo specific treatment
IIMesangial prolifMicro hematuria/proteinuriaNo specific treatment ± ACEI
IIIFocal prolifHematuria/proteinuria, ± HTN, ↓ GFR, ± nephroticInduce: MMF or CYC + steroids Maintenance: MMF >AZA
IVDiffuse prolifHematuria/proteinuria and HTN, ↓ GFR, ± nephroticACEI
VMembranousProteinuria, nephroticIf nephrotic-range proteinuria, induce w/ MMF + steroids
Maintenance: MMF superior to AZA
VIAdv. ScleroticESRDRenal replacement therapy

Min → Mes → Focal → Diffuse → Membranous Sclerotic