Internal Medicine Renal Involvement in Systemic Lupus Erythematosus: Review Questions Carmelita J. Colbert, MD, and Edgar V. Lerma, MD Dr. Colbert is a clinical instructor of medicine, and Dr. Lerma is a clinical associate professor of medicine, Section of Nephrology; both are at the Department of Medicine, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, IL. Choose the single best answer for each question.
	Questions 1 and 2 refer to the following case. A 25-year-old woman presents to her primary care physician with joint pain and a red rash, which first appeared while vacationing in Florida 2 months ago. The rash started over the bridge of her nose and then spread to her cheeks, and it appears to worsen when she is in the sun. The patient states that she has felt tired for the last 3 months but attributed the fatigue to work-related stress. She also has noticed blood in her urine for the last 3 months but was too busy at work to see her physician. On examination, blood pressure is 160/90 mm Hg. Evaluation of the patient’s scalp demonstrates alopecia, and she has significant lower extremity edema. Initial laboratory results demonstrate a hemoglobin level of 9.1 g/dL, a white blood cell count of 4000 cells/µL, a platelet count of 60,000 cells/µL, and a positive antinuclear antibody (ANA) test. 1. Which test should be performed next? Anti-cyclic citrullinated peptide antibody test Anti-double-stranded (ds) DNA test Anti-Sm antibody test Urinalysis Click here to compare your answer. 2. A 24-hour urine collection reveals 3000 mg of protein. Renal biopsy is performed, which reveals cellular proliferation with increased mesangial, epithelial, and endothelial cells and inflammation in more than 50% of glomeruli. Which of the following is most likely associated with this patient’s renal disease? Anti-dsDNA antibodies Anti-RNA antibodies Anti-Sm antibodies Antinuclear antibodies Click here to compare your answer. Questions 3 and 4 refer to the following case. A 30-year-old woman with fatigue, arthralgia, alopecia, and weight loss for 4 months presents to her primary care physician after going to the beach and developing a red rash on her face. The rash initially developed over the bridge of her nose and later spread to her cheeks but spared the nasolabial fold. Urine dipstick analysis demonstrates 2+ protein, microscopic urinalysis reveals dysmorphic erythrocytes and cellular casts, and a 24-hour urine collection reveals 1500 mg of protein. Renal biopsy is performed, which demonstrates increased mesangial, epithelial, endothelial, and inflammatory cells involving more than 70% of glomeruli.		3. What is this patient’s diagnosis? Diffuse membranous glomerulonephritis Diffuse proliferative glomerulonephritis Focal segmental glomerulonephritis Mesangial nephritis Click here to compare your answer. 4. What is the treatment of choice for this patient? Cyclophosphamide alone High-dose intravenous (IV) steroids alone High-dose IV steroids with adjunctive cyclophosphamide Mycophenolate mofetil Click here to compare your answer. 5. A 22-year-old woman presents to her primary care physician with oral ulcers, arthralgias and myalgias in her hands, and fatigue. Urinalysis demonstrates 10 to 12 red blood cells/high-power field, red blood cell casts, and white blood cell casts. A 24-hour urine collection reveals a protein level of 3500 mg. Anti-Sm and anti-dsDNA tests are negative. What is the next step in this patient’s management? Blood pressure monitoring Complete metabolic panel Renal biopsy Renal ultrasound Click here to compare your answer. 6. Which of the following manifestations of systemic lupus erythematosus (SLE) has been strongly associated with a poor outcome? Discoid rash Lupus nephritis Sciatica Pleuritis Click here to compare your answer. 7. Which of the following is the most common cause of death in patients with SLE? Cardiovascular disease Pulmonary hypertension Renal failure Vasculitis Click here to compare your answer.
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