American Board of Internal Medicine (ABIM) Certification Practice Exam

Which therapeutic agents are typically used for the treatment of proliferative forms of lupus nephritis?

1. Mycophenolate mofetil or cyclophosphamide

2. Hydroxychloroquine or sulfasalazine

3. Aspirin or ibuprofen

4. Rituximab or abatacept

The correct answer is: Mycophenolate mofetil or cyclophosphamide

Proliferative forms of lupus nephritis, characterized by renal inflammation and damage, require aggressive treatment to control the disease and prevent further kidney injury. Mycophenolate mofetil and cyclophosphamide are the mainstay therapeutic agents used specifically for this condition. Mycophenolate mofetil is often preferred due to its favorable side effect profile and effectiveness in inducing remission in lupus nephritis. It works by inhibiting lymphocyte proliferation, thereby reducing immune-mediated damage to the kidneys. Cyclophosphamide, while more toxic, is another potent immunosuppressant that may be used in severe cases, especially when rapid control of disease activity is needed. Hydroxychloroquine and sulfasalazine primarily serve as adjunctive treatments for systemic lupus erythematosus and are not effective for managing the proliferative renal involvement characteristic of lupus nephritis. Aspirin or ibuprofen are anti-inflammatory medications that provide symptomatic relief, particularly for pain or inflammation, but do not directly target the underlying autoimmune process affecting the kidneys. Rituximab and abatacept are biologic agents that can be considered for some patients with refractory lupus, but they are not standard first-line treatments for proliferative lupus nephritis. Thus, the agents typically