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Lupus Nephritis — RACP Adult Medicine MCQ

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ModerateNephrologyLupus NephritisRACP Adult Medicine

A 38-year-old woman with SLE presents with nephrotic-range proteinuria and an active urinary sediment. Renal biopsy shows class IV diffuse proliferative lupus nephritis. Anti-dsDNA is strongly positive and C3/C4 are low. What is the recommended induction therapy?

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Correct answer: A — Mycophenolate mofetil (MMF) plus prednisolone

For class III/IV lupus nephritis, induction therapy consists of corticosteroids combined with either mycophenolate mofetil (MMF) or IV cyclophosphamide (Euro-Lupus protocol). MMF is generally preferred as first-line due to comparable efficacy and a better side-effect profile. All patients with SLE and nephritis should also be on hydroxychloroquine. The AURORA trial confirmed voclosporin as an additional option.

Reference: eTG – 2025 – Rheumatology; KDIGO – 2024 – Lupus Nephritis Guidelines