Review Question - QID 107426

This young patient has developed class II lupus nephritis. This condition, although it has potential to progress, is typically managed expectantly, with no indication for escalation of therapy.

Kidney biopsy is warranted to evaluate abnormal kidney function in patients with lupus. This helps confirm the presence of nephritis and classify it based on validated scales of severity. Generally, class I (Minimal mesangial lupus nephritis) and class II nephritis are managed without escalation in therapy, whereas classes III-V necessitate aggressive immunosuppression. The agents commonly used for this include cyclophosphamide and Mycophenolate mofetil.

Gill et al. review the diagnosis of SLE. They state that 4 out of 11 diagnostic criteria must be met to formally diagnose SLE. The 11 criteria are: malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic manifestations, hematological manifestations, +ANA, +other antibody (dsDNA, smith, phospholipid). The titer level of ANA can be helpful as well.

Liu et al. conducted a prospective, randomized control trial to evaluate two induction regimens for lupus nephritis. They compared a combination of tacrolimus, mycophenolate, and prednisone to single-agent cyclophosphamide. There was an approximately 20% difference in remission rate favoring the combination regimen. No difference was seen in adverse events between the two groups.

Incorrect answers:
Answer 1: Although the patient might one day progress to more advanced stages of nephritis and require hemodialysis, there is no indication to refer at present.
Answers 2-3: There is no indication for escalation of therapy for grade II lupus nephritis.
Answer 4: Although prednisone can often be used for lupus flares, there is no other clinical history suggesting active disease.