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Systemic lupus erythematosus — RCPSC IM MCQ

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HardRheumatologySystemic lupus erythematosusRCPSC IM

A patient with systemic lupus erythematosus develops proteinuria 2.4 g/day, hematuria, red-cell casts, low complement and rising anti-dsDNA titres. What is the best next step?

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Correct answer: E — Arrange urgent nephrology assessment and kidney biopsy to classify lupus nephritis

The best answer is “Arrange urgent nephrology assessment and kidney biopsy to classify lupus nephritis”. Active urinary sediment and significant proteinuria suggest lupus nephritis. Biopsy classification guides induction intensity and prognosis; empirical minimal adjustment or delay risks irreversible kidney damage. The biopsy class separates proliferative, membranous and chronic lesions and therefore determines both induction choice and long-term monitoring.

Reference: Canadian Rheumatology Association, clinical guidelines: https://rheum.ca/resources/publications/