LN Steroid Discontinuation Timing — ESENeph MCQ

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HardGlomerulonephritisLN Steroid Discontinuation TimingESENeph

A patient with class III/IV lupus nephritis has maintained complete clinical renal response on maintenance therapy and wishes to stop low-dose glucocorticoids. When can discontinuation be considered under KDIGO 2024?

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Correct answer: B — Consider withdrawal after 12 months of complete response

The best answer is “Consider withdrawal after 12 months of complete response”. KDIGO states that glucocorticoid discontinuation can be considered after complete clinical renal response has been maintained for at least 12 months. Extrarenal lupus activity and relapse history also inform the decision. “Immediately after proteinuria first improves” is less appropriate because early withdrawal carries relapse risk before response is established “At 3 months despite persistent active urine sediment” is less appropriate because this is not a maintained complete response “After one normal creatinine result” is less appropriate because complete renal response requires a sustained clinical pattern, not one value “After maintenance immunosuppression has already been stopped” is less appropriate because glucocorticoid withdrawal is considered within an ongoing maintenance strategy

Reference: KDIGO 2024 lupus nephritis guideline: https://kdigo.org/wp-content/uploads/2024/01/KDIGO_2024_Lupus_Nephritis_Guideline.pdf