A 28-year-old woman with SLE develops worsening renal function, haematuria with red cell casts, proteinuria 3.8 g/day, and complement consumption. Renal biopsy shows diffuse proliferative glomerulonephritis (ISN/RPS Class IV). The MOST appropriate induction immunosuppressive regimen per current EULAR/ACR guidelines is:

• A High-dose oral prednisolone alone for 6 months
• B IV methylprednisolone pulses followed by mycophenolate mofetil 2–3 g/day plus hydroxychloroquine ✓
• C Rituximab monotherapy with no corticosteroids
• D Azathioprine plus low-dose prednisolone (no MMF)

Explanation

For Class III/IV lupus nephritis, EULAR 2019 and ACR 2024 guidelines recommend IV methylprednisolone pulses (500 mg × 3 days) followed by mycophenolate mofetil 2–3 g/day (preferred over cyclophosphamide in most centres outside Asia) combined with low-dose prednisolone. Hydroxychloroquine is added as a background immunomodulator in all SLE patients without contraindications. Azathioprine is reserved for maintenance therapy or pregnancy. Rituximab is used for refractory disease.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.