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Lupus Nephritis — ESENeph MCQ

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HardGlomerulonephritisLupus NephritisESENeph

A 28-year-old woman with SLE develops active Class IV lupus nephritis confirmed on biopsy. Her eGFR is 55 mL/min/1.73m2. She has had two previous renal flares. She is already on Hydroxychloroquine. Which initial treatment regimen is most appropriate according to KDIGO 2024?

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Correct answer: C — Belimumab plus Mycophenolate mofetil plus Glucocorticoids

KDIGO 2024 lupus nephritis guideline now recommends triple therapy including belimumab with glucocorticoids and either MPAA or low-dose IV cyclophosphamide for patients with repeated kidney flares or at high risk of progression (Practice Point 10.2.3.1.5). Belimumab is preferred over CNI in patients with recurrent flares. All patients with SLE should be on hydroxychloroquine unless contraindicated (1C).

Reference: KDIGO 2024 – Clinical Practice Guideline for Lupus Nephritis