Systemic lupus erythematosus: The Daily PANCE Blueprint

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Systemic lupus erythematosus: The Daily PANCE Blueprint

A 19-year-old woman presents with polyarthritis, oral ulcers, and a malar rash. Labs show anemia, leukopenia, proteinuria, and positive ANA. Which of the following findings is most consistent with SLE nephritis?

A. Microscopic hematuria
B. Urinary protein/creatinine ratio of 0.5
C. Red blood cell casts in the urine
D. Serum creatinine 1.1 mg/dL
E. BUN/creatinine ratio of 10:1

Answer and topic summary

The answer is C) Red blood cell casts in the urine.

This patient’s presentation meets the diagnostic criteria for SLE. Lupus nephritis is suggested by proteinuria in the setting of SLE. Red blood cell casts in the urine indicate glomerular bleeding and inflammation, which is most consistent with lupus nephritis as opposed to other causes of proteinuria. Microscopic hematuria and mild proteinuria can occur in SLE but do not definitively indicate nephritis. The serum creatinine and BUN/creatinine ratio may still be normal in early nephritis.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Rheumatologic Disorders ⇒ Systemic lupus erythematosus

Also covered as part of the Internal Medicine EOR and Family Medicine EOR topic list

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