Spontaneous bacterial peritonitis — RCPSC IM MCQ
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Correct answer: D — Arrange urgent kidney biopsy through nephrology and rheumatology
The best answer is “Arrange urgent kidney biopsy through nephrology and rheumatology”. Active sediment, substantial proteinuria and declining kidney function strongly suggest lupus nephritis. Kidney biopsy establishes class and activity/chronicity to guide induction; delayed review, antibiotics, unclassified empiric treatment or withdrawal of therapy risks irreversible injury.
Reference: Canadian Rheumatology Association, lupus resources: https://rheum.ca/resources/publications/