Lupus nephritis — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesLupus nephritisSCE Rheumatology

A 29-year-old woman with known SLE has ankle swelling and new hypertension. Urine protein:creatinine ratio is 145 mg/mmol with dysmorphic red cells. Anti-dsDNA titre has risen and C3 is low. Creatinine has increased from 62 to 96 micromol/L. What is the most appropriate investigation?

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Reveal the answer and explanation

Correct answer: E — Renal biopsy

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as E

Renal biopsy is best because renal biopsy is needed to classify suspected active lupus nephritis and guide immunosuppressive treatment. B is less suitable because anti-CCP is for rheumatoid arthritis phenotype and not lupus nephritis; C is less suitable because waiting 6 months risks irreversible renal injury; D is less suitable because ANA titre does not classify renal disease activity; E is less suitable because contrast CT is not the diagnostic test for immune-complex nephritis. Clinical pearl: proteinuria with active urinary sediment in SLE is biopsy-level disease unless contraindicated.

Reference: EULAR lupus nephritis recommendations 2025; BSR lupus guideline