Info
Mesangial proliferative LN
(class II) The histologic changes with class II disease are manifested clinically by microscopic hematuria and/or proteinuria. Hypertension is → uncommon, and nephrotic syndrome and kidney function impairment are virtually never seen.
Light microscopy with class II disease reveals mesangial hypercellularity (of any degree) or mesangial matrix expansion (picture 2). A few isolated subepithelial or subendothelial deposits may be seen on immunofluorescence or electron microscopy. Visible subendothelial deposits on light microscopy or any global or segmental glomerular scars (which are thought to be the result of previous endocapillary hypercellularity, necrosis, or crescents) are inconsistent with the diagnosis of class II LN. Such findings would indicate either class III or IV disease. Extensive podocyte effacement with nephrotic syndrome can rarely be seen, resembling minimal change disease if there is → an associated podocytopathy.
The kidney prognosis with mesangial proliferative LN is → excellent, and no specific therapy is → indicated unless the patient progresses to more advanced disease or has evidence of extensive podocyte effacement and nephrosis. (See ‘Lupus podocytopathy’ below.)