You need to talk with your doctor because this is a indication that something may be going on with your kidneys.

The BUN/Cr ratio is often elevated due to not being well hydrated.

I think @A MyLupusTeam Member might have answered the question. SInce you have adequate fluid intake and your platelets are down, the decreased platelets indicates drop in blood volume or at least a type of blood that feeds the kidneys. It could be affecting that ratio. Your dr will be able to figure out the puzzle, but I'm betting it is related go the anemia, stressing the kidneys.

It might not be that the plaquenil is not working as well, it just may not be enough to stop whatever is going on in your body at this time. Not sure your dosage, but it may need to be increased or another medication added at least temporarily to combat the increased activity and stress in your body.

Will you let us know what he says? This issue always puzzles me on my results too.

Was your lab done early in the morning? If so, you may not have consumed enough water to allow the balance to restore after the night hours. You wouldn’t technically be dehydrated, just not well hydrated, yet, for the day.

@A MyLupusTeam Member My individual BUN and Creatinine levels were within range (well, the creatinine was on the low end, on the borderline of being below normal). Just the ratio was high and my platelets fell below normal range, not by much, but they were always much higher.
If the ANA is positive despite being on Plaquenil, does that mean Lupus is still active? I mean I still do feel crappy, so maybe the Plaquenil isn't AS effective as I thought 😥