SLE and Autoimmune Disorders MCQ — NEET PG Practice Question | NEETPGAI
SLE and Autoimmune Disorders
medium
microscope Pathology
A 28-year-old woman with systemic lupus erythematosus presents with progressive renal dysfunction and proteinuria. Kidney biopsy is performed. Which of the following is the most common histopathological pattern of lupus nephritis?
A. Class III: Focal proliferative lupus nephritis
B. Class I: Minimal mesangial lupus nephritis
C. Class V: Membranous lupus nephritis
D. Class IV: Diffuse proliferative lupus nephritis
Explanation
Lupus Nephritis Classification and Epidemiology
Key Point
Class IV (diffuse proliferative) lupus nephritis is the most common and most severe form of lupus nephritis, accounting for approximately 40–50% of all lupus nephritis cases and the majority of symptomatic presentations.
WHO/ISN-RPS Classification of Lupus Nephritis
Table
Class
Histology
Prevalence
Prognosis
Clinical Features
I
Minimal mesangial
5–10%
Excellent
Asymptomatic, normal renal function
II
Mesangial proliferative
10–15%
Good
Mild proteinuria, normal GFR
III
Focal proliferative (<50% glomeruli)
20–25%
Fair
Hematuria, proteinuria, mild renal dysfunction
IV
Diffuse proliferative (>50% glomeruli)
40–50%
Poor
Heavy proteinuria, hematuria, renal insufficiency
V
Membranous
10–20%
Variable
Nephrotic syndrome, proteinuria
VI
Advanced sclerosing
5%
Very poor
End-stage renal disease
High-YieldNEET PG
Class IV is subdivided into:
IV-S (segmental): <50% of glomerular tuft involvement
IV-G (global): ≥50% of glomerular tuft involvement
Class IV-G carries the worst prognosis and is most likely to progress to ESRD without treatment.
Clinical Correlation
Clinical Pearl
Patients with Class IV lupus nephritis typically present with:
Heavy proteinuria (often >3.5 g/day, nephrotic range)
Active urinary sediment (RBC casts, WBC casts)
Hypertension
Declining GFR
Elevated anti-dsDNA antibodies and low complement (C3, C4)
Pathophysiology
Class IV nephritis involves immune complex deposition in the subendothelial space and along the glomerular basement membrane, triggering:
1.
Complement activation (C1q, C3, C4 deposition)
2.
Endocapillary or extracapillary proliferation
3.
Wire-loop lesions (pathognomonic for SLE)
4.
Hematoxylin bodies (also pathognomonic)
Warning
Do not confuse Class IV with Class III based on severity alone — the distinction is based on the percentage of glomeruli involved, not clinical severity. However, Class IV is statistically more severe.
Treatment Implications
Class IV lupus nephritis requires aggressive immunosuppression:
Induction: IV methylprednisolone + cyclophosphamide or mycophenolate mofetil
Maintenance: Azathioprine or mycophenolate mofetil + oral corticosteroids
Remission rates: 50–70% with modern regimens
Mnemonic: LUPUS Nephritis Classes — "Most Common = Most Severe"
Lesions: Class IV has diffuse (most) lesions
Usually: Class IV is the usual presentation in symptomatic SLE
Proliferative: Class IV is diffuse proliferative
Unfavorable: Class IV has unfavorable prognosis without treatment
Severity: Class IV correlates with worst outcomes
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