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Lupus nephritis class IV — RACP Paediatrics MCQ

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HardNephrologyLupus nephritis class IVRACP Paediatrics

A 14-year-old girl with SLE presents with nephritic-nephrotic syndrome (haematuria, heavy proteinuria, hypertension, oedema, and elevated creatinine). Complement C3 and C4 are both low. Anti-dsDNA is markedly elevated. Renal biopsy shows diffuse proliferative glomerulonephritis with full-house immunofluorescence. What is the most likely renal diagnosis?

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Correct answer: D — Lupus nephritis class IV

Diffuse proliferative GN (ISN/RPS class IV) with 'full-house' IF pattern (IgG, IgA, IgM, C3, C1q all positive) is the most common and severe form of lupus nephritis. Low C3 and C4 with elevated anti-dsDNA correlate with active renal disease. Treatment is induction immunosuppression (IV methylprednisolone + mycophenolate or cyclophosphamide) followed by maintenance (mycophenolate).

Reference: RCH Melbourne – 2023 – Lupus Nephritis CPG; KDIGO – 2024 – Lupus Nephritis Guidelines