A patient with SLE develops worsening proteinuria. Renal biopsy shows diffuse proliferative glomerulonephritis (Class IV per ISN/RPS classification). Per current ACR guidelines, the induction immunosuppressive regimen of choice is:
- A Mycophenolate mofetil 2–3 g/day + high-dose pulse methylprednisolone ✓
- B Azathioprine 2 mg/kg/day alone as maintenance
- C Hydroxychloroquine 400 mg/day as monotherapy
- D IV cyclophosphamide alone (NIH regimen) without steroids
Correct answer: A. Mycophenolate mofetil 2–3 g/day + high-dose pulse methylprednisolone
Explanation
For lupus nephritis Class III/IV, current ACR (2024) and EULAR guidelines endorse mycophenolate mofetil (MMF 2–3 g/day) plus pulse IV methylprednisolone followed by oral prednisolone as first-line induction — this regimen showed equivalent efficacy to the NIH cyclophosphamide regimen with better tolerability in the ALMS trial. Azathioprine is maintenance therapy, not induction. Hydroxychloroquine is adjunctive, not induction monotherapy. Cyclophosphamide without steroids is not appropriate.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.