05-14-2009, 12:45 PM
A 37-year-old white female presents with low-grade fever, malaise, weight loss, rash on her face, and joint pain for the last 6 months. Joint involvement is migratory and asymmetrical. She is a non-smoker and non-alcoholic. She does not take any medication. Her pulse is 80/min, BP is 160/98 mmHg and the temperature is 39C(104F). Erythematous rash is present over the cheeks and bridge of the nose and is somewhat edematous. Rest of the systemic examinations is unremarkable.
Labs show:
Serum creatinine 3mg/dL
ESR 38 mm/hr
Proteinuria 3 +
Hematuria Positive with RBC casts
ANA Positive
Anti-DsDNA Positive
Diagnosis of lupus nephritis is made and renal biopsy is ordered. Which of the following types of glomerular injury is associated with worst prognosis in systemic lupus erythematosus (SLE) patients?
A. Mesangial type
B. Sclerosing type
C. Diffuse proliferative
D. Focal proliferative
E. Membranous type