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Systemic lupus erythematosus nephritis — RACP Adult Medicine MCQ

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HardRheumatologySystemic lupus erythematosus nephritisRACP Adult Medicine

A 26-year-old woman with SLE develops ankle oedema and hypertension. Urine protein-creatinine ratio is 180 mg/mmol, urine microscopy shows red-cell casts, complement is low and anti-dsDNA is rising. Creatinine has increased from 70 to 112 micromol/L. What is the most appropriate investigation?

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Correct answer: B — Renal biopsy

Active urinary sediment, proteinuria and falling renal function in SLE require renal biopsy to classify lupus nephritis and guide immunosuppression. ANA titre does not reflect renal class or activity. Delayed dipstick, renal angiography and skin biopsy do not answer the key management question.

Reference: Australian Rheumatology Association guidance; Kidney Health Australia/CARI; eTG