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Lupus nephritis — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesLupus nephritisSCE Rheumatology

A 42-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 diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: D — Mycophenolate mofetil

Mycophenolate mofetil is the best answer because mycophenolate mofetil is the most appropriate next step for lupus nephritis in this clinical setting. Urgent antibiotics is a plausible distractor, but it does not account for the key discriminator in the stem. Cyclophosphamide and Bisphosphonate therapy would be more appropriate in a different clinical pattern or at another point in the pathway, while ACE inhibitor therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: BSR SLE guideline; EULAR SLE and systemic sclerosis recommendations; BNF