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Lupus nephritis — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesLupus nephritisSCE Rheumatology

A 27-year-old woman with SLE develops oedema and rising blood pressure. Examination shows malar rash is mild but ankle oedema is present. Investigations show urine PCR 220 mg/mmol, eGFR 58 mL/min/1.73m2 and low complement. What is the most appropriate management?

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Correct answer: A — Urgent renal biopsy and induction immunosuppression planning

Significant proteinuria and renal impairment in SLE require urgent nephrology assessment and renal biopsy to classify lupus nephritis before induction therapy. Hydroxychloroquine is important background treatment but is insufficient for suspected active nephritis. The biopsy class drives the choice and intensity of immunosuppression.

Reference: EULAR SLE recommendations; BSR lupus guideline; NICE TA752; BNF