Rheumatology: lupus nephritis histology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: lupus nephritis histology

Sample item

A 26-year-old woman with SLE has a creatinine of 2.0 mg/dL, hypertension and nephrotic-range proteinuria with red cell casts. Renal biopsy shows endocapillary proliferation in more than 50% of glomeruli, wire-loop lesions and full-house staining on immunofluorescence. Which ISN/RPS class is this?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Class IV diffuse lupus nephritis

Class IV is the commonest and most severe form, with involvement of 50% or more of glomeruli by endocapillary proliferation, subendothelial deposits and wire-loop lesions. It needs induction immunosuppression with glucocorticoids and mycophenolate or cyclophosphamide. Full-house staining refers to IgG, IgA, IgM, C3 and C1q.

Option by option

  • A. Class IV diffuse lupus nephritis (correct)

    Correct. Diffuse proliferation in more than half of glomeruli with wire loops defines class IV.

  • B. Class II mesangial proliferative lupus nephritis

    Class II shows only mesangial hypercellularity and generally mild disease.

  • C. Class I minimal mesangial lupus nephritis

    Class I is normal on light microscopy with mesangial deposits on immunofluorescence only.

  • D. Class V membranous lupus nephritis

    Class V shows subepithelial deposits and thickened capillary walls without diffuse proliferation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Class IV diffuse lupus nephritis. Class IV is the commonest and most severe form, with involvement of 50% or more of glomeruli by endocapillary proliferation, subendothelial deposits and wire-loop lesions.

Why is "Class II mesangial proliferative lupus nephritis" not the answer?

Class II shows only mesangial hypercellularity and generally mild disease.

Why is "Class I minimal mesangial lupus nephritis" not the answer?

Class I is normal on light microscopy with mesangial deposits on immunofluorescence only.

Why is "Class V membranous lupus nephritis" not the answer?

Class V shows subepithelial deposits and thickened capillary walls without diffuse proliferation.

What concept does this question test?

It tests Rheumatology: lupus nephritis histology in General Medicine. It needs induction immunosuppression with glucocorticoids and mycophenolate or cyclophosphamide. Full-house staining refers to IgG, IgA, IgM, C3 and C1q.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: lupus nephritis histology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.