25 yr old homemaker, SLE diagnosed at 14 yrs age was under Rheumatologist care, recently off Methotrexate and switched to Sulfasalazine ( she was also on Pred 10mg, HCQS 200mg BID, low dose aspirin calcium and vitamins) by her rheumatologist as she wanted to conceive (s.creat 1.1mg/dl, Lupus was stable last 3 yrs, protein creat ratio 0.15, complements normal). Now presented with flare-RPGN presentation creat 1.1 to 3 mg/dl over 2 weeks, urine active sediment, 3 gms proteinuria. Biopsy cellular crescents more than 50%, wireloops, class IV, with IV MP and MMF 1.5 gms BD, her creat started comming down to 2.2 and is asymptomatic and doing well.

In view of Bx findings of crescents would IV Cyclophosphomide -Euro lupus be a better option (especially when creatinine is improving) Vs MMF in a young lady as above . do we have strong evidence for MMF as induction agent in crescentic Class IV Lupus Nephritis