A 35-year-old woman with systemic lupus erythematosus presents with edema and dyspnea. Vital signs show BP 148/92 mmHg, HR 98/min, RR 20/min, and SpO2 98% on room air. Urinalysis demonstrates proteinuria (3.2 g/24 hours) and hematuria with RBC casts. Serum creatinine is 1.8 mg/dL. Laboratory studies reveal depressed C3/C4 levels, positive anti-dsDNA and anti-nucleosome antibodies. Renal biopsy shows subendothelial immune deposits with characteristic 'wire-loop' lesions. Complement levels are significantly reduced. Which lupus nephritis class is most likely?
- A)Class III (focal proliferative)
- B)Class VI (advanced sclerosing)
- C)Class IV (diffuse proliferative)GABARITO
- D)Class V (membranous)
- E)Class II (mesangial proliferative)
Explicação
Class IV lupus nephritis is the most severe form with diffuse proliferative changes and subendothelial deposits. The pathognomonic 'wire-loop' lesions (thickened capillary walls from immune deposits), combined with low complement, hematuria, RBC casts, and ele... Ver explicação completa e trilha adaptativa →