Which of the following represents typical clinical and laboratory features of lupus nephritis?

• A. Hematuria with edema and preserved complement levels; kidney biopsy shows no glomerulonephritis.
• B. Hematuria, proteinuria, decreased complement levels (low C3/C4), and elevated creatinine; often GN on biopsy; associated with SLE.
• C. Proteinuria with normal complements and normal creatinine.
• D. Absence of hematuria and low lipids.

Answer: (B)

Lupus nephritis is immune-complex–mediated inflammation of the kidneys that occurs in people with systemic lupus erythematosus. The hallmark is glomerular injury from immune deposits, which typically shows blood and protein in the urine, and signs that the kidneys aren’t filtering well.

This combination is why the best answer includes hematuria and proteinuria, along with a drop in complement levels (low C3 and C4) due to consumption of complement by immune complexes, and a rising creatinine indicating decreased kidney function. A kidney biopsy usually reveals glomerulonephritis with immune deposits, and the condition is tied to SLE.

The other descriptions miss one or more critical elements. For example, lupus nephritis commonly features complement consumption and impaired kidney function, not preserved complements and no GN on biopsy. Normal complements and creatinine are less typical, and the absence of hematuria ignores the glomerular involvement that characterizes lupus nephritis.