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LN Mixed Class V Treatment — ESENeph MCQ

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ModerateGlomerulonephritisLN Mixed Class V TreatmentESENeph

A 38-year-old woman with SLE has a kidney biopsy showing Class V membranous lupus nephritis with nephrotic-range proteinuria but normal eGFR. According to KDIGO 2024, when should the proliferative LN regimen (rather than pure Class V approach) be used?

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Correct answer: B — When there is a mixed Class V component accompanying Class III or IV

KDIGO 2024 LN guideline distinguishes between pure Class V LN and mixed (Class III/IV + V). When there is a membranous component accompanying proliferative disease (Class III+V or IV+V), the treatment follows the proliferative protocol (glucocorticoids plus MPAA, CYC, or triple therapy with Belimumab/CNI). Pure Class V LN has separate management recommendations. The biopsy classification drives treatment selection.

Reference: KDIGO 2024 – Lupus Nephritis Guideline