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Class V Lupus Nephritis — RACP Adult Medicine MCQ

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ModerateRheumatologyClass V Lupus NephritisRACP Adult Medicine

A 35-year-old woman with SLE develops Class V (membranous) lupus nephritis with nephrotic-range proteinuria but preserved renal function (eGFR 90). Anti-dsDNA is elevated and C3/C4 are low. What is the most appropriate induction therapy?

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

Pure Class V lupus nephritis with nephrotic-range proteinuria warrants immunosuppressive induction with MMF plus prednisolone. The threshold for treatment is proteinuria >1 g/day (some guidelines >3.5 g/day). Calcineurin inhibitors (tacrolimus) may be added for refractory nephrotic syndrome. Hydroxychloroquine should be continued throughout.

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