Autoimmunity: lupus nephritis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Autoimmunity: lupus nephritis

Sample item

A 26-year-old woman with malar rash and arthralgia has haematuria, proteinuria of 4 g per day, hypertension and low C3 and C4. Renal biopsy shows endocapillary proliferation in most glomeruli, wire-loop lesions and a full-house pattern on immunofluorescence. Which ISN/RPS class is this?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Class IV, diffuse proliferative lupus nephritis

Class IV lupus nephritis is the commonest and most serious type, with proliferation involving 50% or more of glomeruli, subendothelial immune complex deposits and wire-loop lesions on light microscopy. Full-house immunofluorescence, with IgG, IgA, IgM, C3 and C1q, is characteristic of lupus. It needs intensive immunosuppression to prevent renal failure.

Option by option

  • A. Class V, membranous lupus nephritis

    Class V shows subepithelial deposits with membrane thickening and nephrotic proteinuria, without diffuse proliferation.

  • B. Class I, minimal mesangial lupus nephritis

    Class I has deposits only on immunofluorescence and normal light microscopy.

  • C. Class IV, diffuse proliferative lupus nephritis (correct)

    Correct. Diffuse endocapillary proliferation with wire loops and a nephritic-nephrotic picture is class IV.

  • D. Class II, mesangial proliferative lupus nephritis

    Class II shows mesangial hypercellularity only, usually with mild urinary findings.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Class IV, diffuse proliferative lupus nephritis. Class IV lupus nephritis is the commonest and most serious type, with proliferation involving 50% or more of glomeruli, subendothelial immune complex deposits and wire-loop lesions on light microscopy.

Why is "Class V, membranous lupus nephritis" not the answer?

Class V shows subepithelial deposits with membrane thickening and nephrotic proteinuria, without diffuse proliferation.

Why is "Class I, minimal mesangial lupus nephritis" not the answer?

Class I has deposits only on immunofluorescence and normal light microscopy.

Why is "Class II, mesangial proliferative lupus nephritis" not the answer?

Class II shows mesangial hypercellularity only, usually with mild urinary findings.

What concept does this question test?

It tests Autoimmunity: lupus nephritis in Pathology. Full-house immunofluorescence, with IgG, IgA, IgM, C3 and C1q, is characteristic of lupus. It needs intensive immunosuppression to prevent renal failure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Autoimmunity: lupus nephritis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.