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Class IV Lupus Nephritis — RACP Adult Medicine MCQ

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ModerateRheumatologyClass IV Lupus NephritisRACP Adult Medicine

A 40-year-old woman with known SLE presents with active nephritis. Kidney biopsy shows diffuse proliferative glomerulonephritis (Class IV lupus nephritis). What is the most appropriate induction therapy?

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Correct answer: A — Mycophenolate mofetil plus low-dose prednisolone

For Class III/IV lupus nephritis, EULAR and ACR/KDIGO guidelines recommend mycophenolate mofetil (2–3 g/day) plus low-dose prednisolone as first-line induction. MMF is non-inferior to IV cyclophosphamide with a better side-effect profile. Voclosporin or belimumab can be added to standard therapy for enhanced response. Hydroxychloroquine should be continued in all SLE patients.

Reference: EULAR – 2024 – Lupus Nephritis; KDIGO 2021 GN Guidelines