American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment for SLE when kidney involvement is present?

1. Corticosteroids

2. Hydroxychloroquine

3. Mycophenolate mofetil or Cyclophosphamide

4. Rituximab

The correct answer is: Mycophenolate mofetil or Cyclophosphamide

When systemic lupus erythematosus (SLE) presents with kidney involvement, such as lupus nephritis, the appropriate treatment commonly involves the use of immunosuppressive agents such as mycophenolate mofetil or cyclophosphamide. These medications target the underlying immune dysregulation seen in SLE and are particularly effective in addressing the severe inflammation that occurs in lupus nephritis. Mycophenolate mofetil has become a preferred option due to its favorable side effect profile and effective outcomes in both inducing and maintaining remission in patients with renal involvement from SLE. It works by inhibiting lymphocyte proliferation and thereby reducing the autoantibody production that contributes to the kidney damage commonly seen in these patients. Cyclophosphamide, while effective, is typically reserved for more severe cases or when rapid control of inflammatory activity is necessary. It is associated with more significant side effects and long-term risks compared to mycophenolate mofetil. While corticosteroids are often used as part of the treatment regimen for managing acute flares and controlling inflammation, they are not sufficient alone for treating active lupus nephritis. Hydroxychloroquine plays a supportive role in SLE management, primarily for skin and arthritic manifestations, but does not address