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Lupus Nephritis Class V — ESENeph MCQ

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HardGlomerulonephritisLupus Nephritis Class VESENeph

A 30-year-old woman with SLE and Class V (pure membranous) lupus nephritis has proteinuria of 4.5 g/day and eGFR of 75 mL/min/1.73m2. She is on Hydroxychloroquine. What is the suggested initial management according to KDIGO 2024?

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Correct answer: A — Glucocorticoids plus MPAA or CNI or Cyclophosphamide

KDIGO 2024 lupus nephritis guideline practice point 10.2.4.1 addresses pure Class V LN. Management is suggested with glucocorticoid plus MPAA, CNI, or cyclophosphamide. The evidence base for pure Class V is weaker than for proliferative LN. Triple therapy with belimumab was studied primarily in Class III/IV. In the BLISS-LN trial, Class V patients treated with belimumab plus SOC did not show a clear better remission rate compared to SOC alone.

Reference: KDIGO 2024 – Lupus Nephritis Guideline