Diffuse proliferative nephritis

Diffuse proliferative glomerulonephritis (DPGN) is a type of glomerulonephritis that is the most serious form of renal lesions in SLE and is also the most common, occurring in 35% to 60% of patients. In absence of SLE, DPGN pathology looks more like Membranoproliferative glomerulonephritis

In DPGN Most of the glomeruli show endothelial and mesangial proliferation, affecting the entire glomerulus, leading to diffuse hypercellularity of the glomeruli, producing in some cases epithelial crescents that fill Bowman's space. When extensive, immune complexes create an overall thickening of the capillary wall, resembling rigid "wire loops" on routine light microscopy. Immune complexes can be visualized by staining with fluorescent antibodies directed against immunoglobulins or complement, resulting in a granular fluorescent staining pattern. Electron microscopy reveals electron-dense subendothelial immune complexes (between endothelium and basement membrane). In due course, glomerular injury in DPGN gives rise to scarring (glomerulosclerosis). Most of SLE patients with DPGN have hematuria with moderate to severe proteinuria, hypertension, and renal insufficiency.