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Internal Medicine

Answer 5
  1. Renal biopsy. Biopsies are not required to diagnose lupus nephritis but are extremely helpful when the diagnosis is highly suspected but symptoms are not suggestive.6 This patient has several manifestations of SLE (ie, joint pain, oral ulcers, proteinuria), but at least 4 criteria should be met to make a diagnosis. Although both anti-dsDNA and anti-Sm antibody tests are negative in this case, these tests are 100% specific for SLE but are not very sensitive.7 Tissue biopsy can confirm the diagnosis and assess disease severity. Given the importance of identifying pathologic features suggestive of more aggressive disease (eg, crescents), some use results of renal biopsy to guide therapeutic decisions.

     Mills JA. Systemic lupus erythematosus. N Engl J Med 1994;330:1871-9.

    7. Arbuckle MR, McClain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 2003;349:1526-33.

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