A 27-Year-Old Woman With Knee Pain and Facial Rash: Osmosis USMLE Study Question

November 13, 2020

This patient has characteristic symptoms of systemic lupus erythematosus (SLE), namely a "butterfly" rash over the bridge of her nose and cheeks, as well as arthritis, and fatigue. However, she also has hypertension, peripheral edema, and an abnormal urinalysis, which point to a more specific diagnosis of lupus nephritis.

Lupus nephritis is histologically evident in most patients with SLE, even those without clinical manifestations of renal disease. Evaluating renal function in SLE patients is important because early detection and treatment of renal involvement can significantly improve renal outcome. Additionally, renal biopsy should be considered in any patient with SLE who has clinical or laboratory evidence of active nephritis (this patient has both), especially after the first episode of nephritis.

By revealing the histologic pattern and stage of disease (activity and chronicity), renal biopsy is useful in determining prognosis and treatment. The principal goal of therapy in lupus nephritis is to normalize renal function or, at least, to prevent the progressive loss of renal function. This is achieved using corticosteroids and other immunosuppressive agents.

Major Takeaway: Lupus nephritis is a cause of nephritic syndrome occurring in patients with SLE. Characteristic symptoms of SLE include facial rash, arthritis, and fatigue. Nephritic syndrome is characterized by the loss of both protein and erythrocytes in the urine. Renal biopsy is used for diagnosis and planning treatment.

Read more about lupus nephritis.

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