Background: Lupus nephritis affects all renal compartments namely glomeruli, tubules, interstitium and blood vessels. However the ISN/RPS classification of Lupus nephritis depends only on the glomerular changes without any assessment of tubulointerstitial and vascular changes in renal biopsy.

Objectives: 1) To describe the tubulointerstitial and vascular changes in in renal biopsies of six classes of lupus nephritis-ISN/RPS Classification of Lupus nephritis (2004).

2) To describe the immunofluorescent patterns in tubulointerstitium and blood vessels.

Methods:

Study Design: Descriptive study

Study Population: Renal biopsies of clinically and biopsy-proven Lupus nephritis patients irrespective of age and sex which were received in the Department of Pathology, Government medical college, Kottayam during the study period.

Sample Size: 37

Sampling Procedure: Continuous sampling

Results: Tubulointerstitial changes were more prevalent in Class IV cases followed by Class III. Interstitial inflammation was seen in 70% cases, Tubular atrophy in 51% cases, and interstitial fibrosis in 35% cases. Vascular changes were detected in 51% of the study population, more prevalent in Class IV and III cases. Arteriolosclerosis was found in 24% cases, vascular immune deposits in 14% cases, Non-inflammatory necrotizing vasculopathy in 8% cases, and vascular thrombi in 5% cases. Tubular immune complex deposits were observed in 30% cases.

Conclusion: Since the treatment and prognosis are based on the ISN/RPS class of Lupus nephritis, we need a better assessment of each patient by seeing tubulointerstitial and vascular changes also, in addition to glomerular changes.

Keywords: Lupus nephritis, tubulointerstitial changes, vascular changes.

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Dr Rinku Susan Kurian

Post Graduate Student, Department of Pathology, Govt. Medical College, Kottayam, Kerala, India