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Lupus nephritis — SCE Rheumatology MCQ

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HardConnective tissue diseasesLupus nephritisSCE Rheumatology

A 28-year-old woman with SLE develops ankle oedema and rising blood pressure. Urine protein:creatinine ratio is 184 mg/mmol, urine microscopy shows red cell casts, creatinine is 118 µmol/L, C3/C4 are low and anti-dsDNA titre has doubled. What is the most appropriate investigation?

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Correct answer: B — Renal biopsy

Active urinary sediment, proteinuria, renal impairment and serological flare suggest lupus nephritis, but class and chronicity determine treatment. Renal biopsy is therefore the key investigation before choosing induction immunosuppression where feasible. ANA titre is not useful for monitoring activity once SLE is established.

Reference: BSR SLE guideline; EULAR/ERA-EDTA lupus nephritis recommendations