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Lupus Nephritis Classification — RACP Paediatrics MCQ

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HardNephrologyLupus Nephritis ClassificationRACP Paediatrics

A 12-year-old girl with SLE presents with proteinuria (urine PCR 300 mg/mmol), haematuria, and rising creatinine. Her ANA and anti-dsDNA are positive. Complement C3 and C4 are both low. What investigation confirms the class of lupus nephritis?

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Correct answer: D — Renal biopsy with ISN/RPS classification

Lupus nephritis classification (ISN/RPS, Classes I-VI) requires renal biopsy. Class IV (diffuse proliferative) is the most common and most severe form. Treatment is guided by biopsy class: mild disease may require low-dose immunosuppression while Class III/IV/V requires aggressive induction (corticosteroids + MMF or cyclophosphamide) followed by maintenance therapy.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Lupus Nephritis