A 28-year-old woman has noticed increasing lower limb swelling and shortness of breath. She has a 2-year history of facial rash, hair loss, arthralgias, and thrombocytopenia. On examination, her blood pressure is 150/90 mmHg, pulse 80/min, there is a maculopapular rash on her face, JVP is 4 cm, heart sounds normal, lungs clear, and there is pedal and periorbital edema. Her creatinine is very high, a urinalysis reveals many RBCs and RBC casts. A renal biopsy is performed.For the above patient with GN, select the most likely diagnosis on renal biopsy.
diffuse proliferative GN
crescentic GN
focal proliferative GN
membranoproliferative GN
Systemic lupus erythematosus (SLE) can cause a wide variety of renal disorders, and can progress to ESRF. Because of the active urine sediment this individual has a proliferative GN. It is difficult to diagnose the type of glomerular involvement in SLE without a biopsy. Based on the biopsy results lupus nephritis (LN) is divided into 6 classes (WHO classification). Class I, minimal mesangial LN; Class II, mesangial proliferative LN; Class III, focal LN; Class TV, diffuse segmental LN; Class V, membranous LN; and Class VI, advanced sclerosing LN.
Oncology