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Internal Medicine

Answer 1
  1. Urinalysis. This patient has 6 of the 11 diagnostic criteria for SLE: malar rash that developed from the bridge of the nose to the cheeks and spared the nasolabial fold, photosensitivity, alopecia, symmetric polyarthritis, anemia, and a positive ANA test. Renal involvement significantly affects the morbidity and mortality of patients with SLE.1 Glomerulonephritis is clinically silent and may only be suspected if the patient has accompanying hypertension or edema. Urine protein level is a measurement of renal lupus activity. Microscopic analysis of a fresh sample of urine is the most sensitive clinical assay for detecting glomerulonephritis and may reveal dysmorphic erythrocytes and cellular casts before serum creatinine becomes elevated. A baseline 24-hour urine collection also should be performed to measure protein, creatinine, and free cortisol or steroid metabolite levels and to calculate creatinine clearance.

     Balow JE. Clinical presentation and monitoring of lupus nephritis. Lupus 2005;14:25-30.

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