Which statement regarding the renal involvement associated with SLE is true?
Correct Answer: Renal biopsy is not initially necessary in patients with deteriorating renal function and active urine sediment
Description: Renal disease is clinically evident in about half of persons with SLE. However, nearly all persons with SLE have some evidence of renal disease on renal biopsy. Renal disease associated with SLE includes both glomerulonephritis and interstitial nephritis. Glomerular disease has been classified into membranous nephritis and mesangial, focal, and diffuse glomerulonephritis. Immune-complex interstitial nephritis occurs most commonly in persons who have diffuse glomerulonephritis. Urinalysis performed in persons with active renal disease usually reveals microscopic hematuria, red cell casts, and proteinuria; the exception is membranous lupus nephritis, in which proteinuria is the dominant finding. Drug-induced lupus rarely leads to renal disease. Anti-dsDNA antibodies at high titer are associated with severe nephritis. Renal biopsy is not necessary in SLE patients whose renal function is rapidly deteriorating when they have an active sediment. If such patients fail to respond to the prompt initiation of glucocorticoid therapy demanded in such a situation, then biopsy should be undertaken. Patients with mild clinical disease should have a biopsy to determine if they have active, severe, inflammatory lesions, which might respond to therapy.
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