skip to main content

LN Maintenance Duration — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

HardGlomerulonephritisLN Maintenance DurationESENeph

A woman with previously treated class IV lupus nephritis develops rising proteinuria and a gradual eGFR fall. Complement and anti-dsDNA are unchanged, urine sediment is bland and cumulative immunosuppression has been substantial. What is the best next step before escalating treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Repeat kidney biopsy before escalating treatment

Clinical biomarkers do not reliably distinguish active lupus nephritis from chronic scarring, podocytopathy, thrombotic microangiopathy or another superimposed lesion. When the result will change a high-risk treatment decision, repeat biopsy can quantify activity and chronicity and prevent unnecessary escalation of immunosuppression. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO 2021 Glomerular Diseases Guideline. https://kdigo.org/guidelines/gd/