A 32-year-old woman with SLE on hydroxychloroquine develops worsening proteinuria (2.8 g/day), hematuria, and a rising creatinine (1.8 mg/dL). Renal biopsy shows diffuse proliferative glomerulonephritis with full-house immunofluorescence. According to EULAR/ACR 2024 guidelines, the preferred induction therapy in this patient is:
- A High-dose prednisone plus mycophenolate mofetil (MMF) ✓
- B High-dose prednisone alone
- C Rituximab monotherapy
- D Pulse IV cyclophosphamide (Euro-lupus regimen) alone
Correct answer: A. High-dose prednisone plus mycophenolate mofetil (MMF)
Explanation
Class III/IV lupus nephritis is treated with combination immunosuppression. Current EULAR 2019/ACR 2024 guidelines recommend high-dose corticosteroids plus either mycophenolate mofetil (MMF) 2–3 g/day or low-dose IV cyclophosphamide (Euro-lupus: 500 mg every 2 weeks x6 doses) as induction. MMF has equivalent efficacy to cyclophosphamide with a better safety profile (less gonadotoxicity) in non-Black patients, making it preferred first-line. Rituximab is reserved for refractory disease. Steroids alone are insufficient induction for Class IV nephritis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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