Question

A woman presents to you with fever, arthralgia, ulcers, fatigue for the past six months, and new-onset hematuria. Urine examination reveals RBC casts and proteinuria. What is the likely diagnosis?

• A. Acute interstitial nephritis
• B. Poststreptococcal glomerulonephritis
• C. Lupus nephritis
• D. gA nephropathy

Answer 1

The Correct Option is C

This clinical scenario describes a woman with systemic symptoms like fever, arthralgia (joint pain), ulcers, and fatigue lasting six months, coupled with recent onset hematuria. The urine examination shows RBC casts and proteinuria. These clinical findings are critical in forming the diagnosis:

• Fever, arthralgia, ulcers, fatigue: These are common systemic manifestations of systemic lupus erythematosus (SLE).
• RBC casts and proteinuria: These suggest glomerular involvement, often seen in glomerulonephritis types, particularly as part of lupus nephritis in SLE.
• Hematuria: The presence of blood in urine seen alongside proteinuria and RBC casts further supports a glomerular cause, like lupus nephritis.

Comparing the given options:

• Acute interstitial nephritis: Typically presents with fever, rash, and eosinophils in urine, not RBC casts and proteinuria.
• Poststreptococcal glomerulonephritis: Often follows streptococcal infection with different demographic patterns (e.g., children) and wouldn't usually match the systemic symptoms here.
• IgA nephropathy: Hematuria present but typically lacks the full systemic presentation (fever, arthralgia, ulcers) shown here.
• Lupus nephritis: Fits all provided symptoms. SLE with renal involvement (lupus nephritis) explains the systemic symptoms, renal findings, and demographic (more common in women).

Thus, the most fitting diagnosis given these observations is Lupus nephritis.