Clinicopathological correlation in lupus nephritis: a 5-year tertiary center experience using International Society of Nephrology/Renal Pathology Society classification.

Background and objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predisposes individuals to multiple organ involvement, with renal complications, particularly lupus nephritis (LN), which is common and clinically significant. The classification and prognosis of LN largely depend on renal biopsy findings, including histopathology, direct immunofluorescence (IF), and electron microscopy. This study aimed to correlate clinicopathological features of SLE patients with LN classes according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. Methods: This retrospective cohort study was conducted over 5 years and included 65 patients with biopsy-proven LN. Patients were categorized into six histological classes based on the ISN/RPS 2003 classification. Demographic, clinical, laboratory, histopathological, and IF data were collected and correlated. Statistical analysis was performed, and a Results: Anemia was the most frequent hematological abnormality. Class IV LN was the predominant histologic subtype in 56.92% of the cases. Statistically significant associations were found between LN class and serum creatinine level, estimated glomerular filtration rate, proteinuria, and activity index. Interstitial fibrosis and tubular atrophy significantly correlated with elevated serum creatinine levels. Conclusion: This study highlights strong clinicopathological correlations in LN, especially between renal function parameters and histological indices. The integration of routine renal profiles, urine analysis, and histological scoring can guide clinical decision-making and underscore the utility of repeat biopsies during follow-up.