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Clinical Case 21
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1

LE is a 14 year-old girl that has a past history of systemic lupus that was previously treated with corticosteroids and hydroxychloroquine. She was lost to follow-up approximately 6 months ago and returns for reevaluation due to the gradual recurrence of skin rash and arthralgias of her knees since discontinuing her medicines. She has no other complaints. Her physical examination is notable only for a malar rash with a butterfly distribution and mild warmth and thickening of her left knee.

Laboratory: WBC 3,500 with mild lymphocytosis HCT 32 PLT 160K ESR 42
Creatinine 0.8 Urinalysis: trace protein, trace blood, dip otherwise negative

Which statement is most correct?
A)There is no evidence of lupus nephritis in this patient, and she should be restarted on NSAIDs alone for a mild SLE flare.
B)b. The findings on urinalysis in this case are suggestive of severe lupus nephritis. The patient should be started on steroids and cyclophosphamide immediately.
C)The extent of renal disease from SLE in this patient is indeterminate. Renal biopsy is warranted to assess the degree of renal involvement.
D)The flare of SLE in this patient off treatment should be treated with corticosteroids and she should have a repeat urinalysis. The calculation of GFR [based on 24 hour urine] is needed in 1 month.





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