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SLE — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeSLESCE Rheumatology

A 29-year-old woman with SLE has low C3 falling anti-dsDNA titres rising from 40 to 180 IU/mL and new microscopic haematuria. She feels well. What is the most appropriate action?

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Correct answer: D — Arrange urgent renal biopsy

Rising anti-dsDNA with falling complement and new microscopic haematuria strongly suggests evolving lupus nephritis. Even in the absence of overt symptoms, renal biopsy is indicated to determine the histological class and guide treatment. Delaying treatment risks irreversible renal damage. Empiric steroid therapy without histological confirmation is not optimal as the treatment intensity depends on the biopsy class.

Reference: EULAR 2023 - Recommendations for management of SLE; ACR/EULAR guidelines for lupus nephritis