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Class IV lupus nephritis — ESENeph MCQ

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HardGlomerulonephritisClass IV lupus nephritisESENeph

A 31-year-old woman with systemic lupus erythematosus develops facial swelling and hypertension. Creatinine has risen from 72 to 166 micromol/L; urine PCR is 480 mg/mmol. C3 and C4 are low and anti-dsDNA is high; biopsy shows diffuse endocapillary proliferation involving more than half of glomeruli. What is the most appropriate management?

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Correct answer: D — Glucocorticoid plus mycophenolate mofetil induction

Diffuse proliferative lupus nephritis with impaired kidney function and active urinary findings requires immunosuppressive induction, commonly glucocorticoid plus mycophenolate or low-dose intravenous cyclophosphamide. ACE inhibition is useful for proteinuria but is not sufficient for active class IV disease. Plasma exchange is not routine first-line therapy unless there is a specific indication such as severe pulmonary haemorrhage. The clinical pearl is that biopsy class, chronicity and activity guide therapy more reliably than serology alone.

Reference: KDIGO 2024 Lupus Nephritis Guideline; BSR lupus guidance