A nurse is assessing a client who has systemic lupus erythematosus (SLE) and is demonstrating signs of kidney involvement. Which of the following findings should the nurse anticipate?

Choice A rationale An elevated Blood Urea Nitrogen (BUN) of 62 mg/dL is a significant indicator of impaired renal function, which is a common complication of systemic lupus erythematosus known as lupus nephritis. The normal range for BUN is typically between 7 and 20 mg/dL. When the kidneys are damaged by the deposition of immune complexes, the glomerular filtration rate decreases, leading to the accumulation of nitrogenous waste products in the blood. This finding strongly suggests active renal involvement. Choice B rationale A positive Antinuclear Antibody (ANA) titer is a hallmark laboratory finding in systemic lupus erythematosus, reflecting the systemic autoimmune nature of the disease. While a positive ANA is not specific to kidney damage itself, its presence is a prerequisite for the diagnosis of SLE and the subsequent development of organ-specific complications. In the context of a patient demonstrating signs of kidney involvement, the ANA titer confirms the underlying autoimmune process that is likely driving the inflammation and destruction within the renal parenchyma. Choice C rationale A hemoglobin level of 19 gm/dL is abnormally high, as the normal range for adults is approximately 12 to 18 gm/dL depending on gender. In systemic lupus erythematosus, patients are much more likely to exhibit anemia of chronic disease or hemolytic anemia, which would result in a low hemoglobin level. An elevated hemoglobin level is not a clinical feature of SLE or lupus nephritis and may instead suggest dehydration or polycythemia, which are unrelated to the pathophysiology. Choice D rationale The presence of 2+ protein in the urine, or proteinuria, is a classic clinical manifestation of glomerular damage in patients with systemic lupus erythematosus. Lupus nephritis occurs when autoantibodies and complement proteins form complexes that lodge in the basement membrane of the kidneys. This inflammatory process increases the permeability of the glomeruli, allowing large molecules like albumin to leak into the urine. Proteinuria is often used as a primary marker to monitor the progression of renal disease. Choice E rationale A platelet count of 150,000/mm falls within the lower end of the normal range, which is typically 150,000 to 450,000/mm. While patients with systemic lupus erythematosus may experience thrombocytopenia due to the production of anti-platelet antibodies, a count of 150,000 does not indicate a pathological state or direct kidney involvement. This value is considered stable and would not be an anticipated finding specifically used to identify or monitor the progression of renal dysfunction in a client with SLE.