The presented cases put before us a new challenge to decide how all of these considerations help in the clinical setting and whether we should start anew and find out the clinical importance of LN histological lesions, putting aside the classification. Whether a new classification could be the key or relying on the existing one but separating glomerular, interstitial and vascular lesions – some of which are not even incorporated in the current classification scheme – is a discussion currently held by scientists and clinicians involvedin the clinical management of LN. A recent study by Rijnink et al. in which the LN classification was set aside and multiple, individual histopathological lesions were scored and related to outcome, suggested that at least fibrinoid necrosis, fibrous crescents, and interstitial fibrosis/tubular atrophy warrant explicit independent scoring to assess the risk of progressive renal dysfunction. The study suggest that the LN classification should include an index of evidence-based prognosticators, also in conjunction with clinical findings. .
In the spirit of change, apart from looking at the various patterns, another important point when reporting histopathological findings is assessing and stating the activity and chronicity indices, especially when multiple biopsies are available from the same patient. This recommendation, together with new definitions for glomerular lesions and other recommendations can be found in a recent consensus report on the LN classification (4).
The histopathological classification for LN is an important determinator for the therapy of LN. The latest edition of the classification is hampered by interobserver disagreement amongst pathologists and the creation of multiple subclasses of which the clinical utility is uncertain. Recommendations to adjust the classification scheme were recently made, and there is a continuous effort to make the definitions more clear, point all variants of histological classes and ultimately to improve the pathohistological classification of LN in hope that it will contribute to better clinical management of the patients.