A 34-year-old woman with a 6-year history of systemic lupus erythematosus presents to the emergency department with dyspnea and bilateral ankle edema. Her medications include prednisone and hydroxychloroquine. Vital signs: BP 158/96 mmHg, HR 88 bpm, RR 18, temperature 37.2°C. Laboratory values show serum creatinine 3.5 mg/dL (baseline 0.8 mg/dL), BUN 62 mg/dL, and eGFR 18 mL/min/1.73m². Urinalysis reveals RBC casts, dysmorphic red blood cells, and 2+ proteinuria. Serum complement C3 and C4 levels are both depressed. Renal ultrasound shows normal-sized kidneys without hydronephrosis. Which of the following is the most likely diagnosis?
- A)Acute tubular necrosis from sepsis
- B)Prerenal acute kidney injury from dehydration
- C)Acute interstitial nephritis from drug reaction
- D)Acute proliferative lupus nephritis (class IV)GABARITO
- E)Thrombotic thrombocytopenic purpura
Explicação
This patient has acute proliferative (class IV) lupus nephritis, which is the most common and severe form of lupus nephritis. The clinical hallmark is the combination of: (1) active urinary sediment with RBC casts and dysmorphic RBCs indicating glomerulonephri... Ver explicação completa e trilha adaptativa →