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Spontaneous bacterial peritonitis — RCPSC IM MCQ

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HardGastroenterology/HepatologySpontaneous bacterial peritonitisRCPSC IM

A patient with systemic lupus develops 1.8 g/day proteinuria, dysmorphic hematuria, red-cell casts and falling complement. Creatinine has risen from 70 to 118 µmol/L. What is the most appropriate next step?

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Correct answer: DArrange 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/