Lupus nephritis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardConnective Tissue DiseasesLupus nephritisSCE Rheumatology

A 31-year-old woman has biopsy-proven class IV lupus nephritis. eGFR is 72 mL/min/1.73 m², UPCR is 280 mg/mmol and anti-dsDNA is high. She has no infection and pregnancy test is negative. She wishes to preserve fertility and is able to use reliable contraception. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Mycophenolate mofetil with glucocorticoids

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

Mycophenolate mofetil with glucocorticoids is best because proliferative lupus nephritis usually requires induction with mycophenolate or cyclophosphamide plus glucocorticoids, with fertility considerations favouring mycophenolate where suitable. A is less suitable because methotrexate is not lupus nephritis induction therapy; C is less suitable because prednisolone alone has inferior renal control and higher toxicity; D is less suitable because etanercept is not a lupus nephritis treatment; E is less suitable because hydroxychloroquine is important background therapy but inadequate alone for class IV disease. Clinical pearl: biopsy class, renal function, fertility and pregnancy plans shape induction choices.

Reference: EULAR lupus nephritis recommendations 2025; BNF