The nurse reviews the serum laboratory results of a client who was seen in the clinic 2 days ago for worsening joint pain from a flare of systemic lupus erythematosus. Which result is of greatest concern and prompts the nurse to notify the health care provider?

Question

Quizplus · Accepted Answer

Systemic lupus erythematosus (SLE) is an autoimmune disorder in which an abnormal immune response leads to chronic inflammation of different parts of the body. SLE ranges in severity from mild (eg, affecting skin, muscles, joints) to severe (eg, affecting kidneys, heart, lung, blood vessels, central nervous system) disease. Increased creatinine (normal 0.6-1.3 mg/dL [53-115 µmol/L]), increased blood urea nitrogen (normal 6-20 mg/dL [2.1-7.1 mmol/L]), and an abnormal urinalysis (eg, protein, red blood cells, cellular casts) can indicate the presence of lupus nephritis (occurring in 50%), a potentially serious complication of SLE. Early recognition and aggressive immunosuppressive treatment are essential to preserve renal function and prevent irreversible kidney damage (Option A). (Option B) An elevated erythrocyte sedimentation rate (normal <30 mm/hr) can indicate the presence of an active inflammatory process and would be expected in a client with an inflammatory disease such as SLE, especially during a disease flare. This is nonspecific and does not give information as to which organ is being attacked by inflammation. (Option C) A positive antinuclear antibody (ANA) titer (>1:40) indicates the presence of ANAs, which the body produces against it own DNA and nuclear material. This would be expected in a client diagnosed with SLE. (Option D) Anemia, mild leukopenia (white blood cell count <4,000/mm³ [4.0×10⁹/L]), and thrombocytopenia (platelet count <150,000/mm³ [150×10⁹/L]) are often present in SLE. The nurse would report these to the health care provider, but they are not of greatest concern. Educational objective: Increased serum creatinine (>1.3 mg/dL [115 µmol/L]), increased blood urea nitrogen (>20 mg/dL [7.1 mmol/L]), and an abnormal urinalysis can indicate the presence of lupus nephritis, a potentially serious complication of SLE in which inflammation of the kidney can lead to renal injury. Early recognition and treatment are essential to preserve renal function and prevent irreversible kidney damage.

The Nurse Reviews the Serum Laboratory Results of a Client