Systemic lupus erythematosus&nbsp;&nbsp;&nbsp;

What would be the clinical role of SGLT-2 inhibitors for lupus nephritis given it has an indication for proteinuria related to CKD?

6 Answers available

When would you consider a kidney biopsy in a patient with longstanding diabetes and hypertension (baseline creatinine 4-5, 4+ proteinuria) who was recently found to have dsDNA positivity?

How would you approach a patient with class III and V lupus nephritis, already on HCQ, MMF, voclosporin and losartan, but has continued proteinuria not yet attaining complete renal response?

Would you consider a dose of rituximab?

4 Answers available

What do you feel are the potential barriers to widespread use of obinutuzumab in proliferative lupus nephritis?

What key factors will you consider when selecting patients for this therapy?This question is part of a collaboration with RheumMadness and i...

In the treatment of lupus nephritis, which patients may benefit from the use of rituximab or other B-cell depleting agents during induction?

This question is part of a collaboration with RheumMadness and is specifically in reference to: Obinutuzumab in Lupus Nephritis

How would you manage a patient with CKD4 due to lupus nephritis of unknown class who develops AKI requiring hemodialysis and nephrotic range proteinuria and is found to have atrophic kidneys on imaging?

How do you counsel patients who experience diarrhea from mycophenolate mofetil (Cellcept)?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?

Should HCQ be continued in an asymptomatic SLE patient who has received renal transplant?

If a patient has received a kidney transplant for SLE-LN and is stable and doing well. Managed by their transplant team and on chronic immunosuppressi...

Would you use voclosporin or belimumab as adjunctive therapy for treatment of lupus nephritis?

How does the presence of extra-renal manifestations influence this decision?

8 Answers available

What is your threshold to repeat a kidney biopsy in a patient with a history of lupus nephritis who is on maintenance therapy and develops subtle changes in urinary protein excretion or microscopic hematuria?

Do you hospitalize patients with newly diagnosed lupus nephritis and nephrotic syndrome if you are able to provide pulse steroids outpatient and follow them closely?

When do you decide to hospitalize?

Do you require lupus patients with ESKD or advanced CKD to be on minimal immunosuppression around the time of kidney transplantation?

How would you approach the management of a new SLE patient presenting with lupus podocytopathy with FSGS and severe proteinuria (Pr/Cr 18) without immune complex deposition?

Would you feel comfortable adding benlysta to patient already taking both mycophenolate and tacrolimus (and hydroxychloroquine) who still has some evidence of active lupus nephritis?

Would you treat a patient aggressively for lupus nephritis if they have persistent proteinuria over 1 gram but cannot get a timely kidney biopsy?

Would you add voclosporin to mycophenolate for refractory proteinuria in a patient with low EF?

Low EF in the range of 30%

At what point would you consider anticoagulation in a pregnant patient with lupus nephritis and non-nephrotic range proteinuria?

Is there a role for eculizumab in the management of refractory lupus nephritis?

How do you approach “clearing” a patient with SLE and ESRD for renal transplant?

A specific example would be a clinically quiescent but serologically active patient.

What do you use for treatment induction in pure class V lupus nephritis with nephrotic-range proteinuria when MMF is contraindicated?

In which clinical scenarios is relying on the urine protein-to-creatinine ratio as a measure of proteinuria unreliable, and interpretations should be made looking at urine protein and urine creatinine separately?

What is your approach to using NIH activity and chronicity indices from renal biopsy in tailoring immunosuppression to a patient with new lupus nephritis?

How do you approach the management of immunosuppression in patients with lupus nephritis that go on to dialysis?

How do steroids and/or DMARDs affect biopsy results if a renal biopsy for suspected lupus nephritis is delayed?