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Lupus nephritis — SCE Rheumatology MCQ

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HardConnective tissue diseasesLupus nephritisSCE Rheumatology

A 47-year-old woman has SLE and develops ankle swelling with frothy urine. Examination shows blood pressure is 152/94 mmHg with mild pedal oedema. Investigations show urinalysis shows blood and protein with low C3 and rising anti-dsDNA. The consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: C — Renal biopsy

The best answer is “Renal biopsy”. Renal biopsy is the best answer because renal biopsy is the investigation most likely to resolve the immediate diagnostic or monitoring question in lupus nephritis. Nailfold capillaroscopy is a plausible distractor, but it does not account for the key discriminator in the stem. Autoantibody profile and Urine protein:creatinine ratio would be more appropriate in a different clinical pattern or at another point in the pathway, while Ultrasound-guided aspiration is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: EULAR lupus nephritis recommendations: https://ard.bmj.com/content/79/6/713