Rheumatology

Glomerulonephritis

Questions discussed in this category

Over what timeline do you typically try to escalate your LN patients to triple therapy?

Do you aim to start your recently diagnosed LN patients on triple therapy before they leave the hospital? Do you start them concurrently or do you use...

4 Answers available

Are there instances when you consider rituximab first line in a patient with class V LN?

Do you only reserve this for refractory cases?

2 Answers available

What steroid regimen do you typically use for induction therapy in patients with lupus nephritis?

How do the 2024 ACR Lupus Nephritis Guidelines impact your timeline for taper?

6 Answers available

What is your approach to treating IgA nephropathy in patients who also have IgA vasculitis?

1 Answer available

What factors do you weigh most heavily when choosing between belimumab and voclosporin as part of a triple therapy regimen for newly diagnosed class IV LN?

2 Answers available

What factors do you consider when advising a patient with lupus nephritis on the safety of becoming pregnant?

3 Answers available

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

Would you check ANCA titers in a patient with a history of PR-3-ANCA glomerulonephritis in remission and a stable creatinine but with recurrent microscopic hematuria?

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?

1 Answer available

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

Do you wait until serum anti-GBM antibody titers are undetectable before hospital discharge in a patient with anti-GBM antibody disease with renal involvement who is receiving daily plasmapheresis, cyclophosphamide, and steroids?

1 Answer 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...

2 Answers available

What would be your approach to managing severe ANCA-associated vasculitis in a patient who is also septic from a bacterial infection?

1 Answer available

What is your treatment approach when managing patients with relapsing lupus nephritis who previously achieved remission with mycophenolate and steroids?

6 Answers available

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

2 Answers available

Do you recommend initiating immunosuppression and plasmapheresis in patients with dialysis dependent AKI in the setting of anti-GBM disease who do not have pulmonary involvement?

1 Answer available

What is your treatment approach for pregnant patients with IgA nephropathy who have worsening proteinuria during the first trimester?

1 Answer available

How would you approach the treatment for patients with renal-limited ANCA vasculitis who have persistent proteinuria, hematuria, and ANCA titers and have completed a steroid taper and received three doses of rituximab?

1 Answer available

Do you ever combine voclosporin and belimumab in the treatment of lupus nephritis?

Do you use them sequentially or together?

3 Answers available

How do you approach the management of patients with suspected membranous lupus nephritis who are found to have positive PLA2R antibodies?

1 Answer available

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?

3 Answers available

What is your approach for steroid dosing for patients with ANCA vasculitis on induction treatment with rituximab, avacopan, and glucocorticoid therapy?

1 Answer available

What are your management strategies for patients with biopsy proven IgA nephropathy with rapidly progressive glomerulonephritis?

2 Answers available

How do you manage a pregnant patient with lupus who develops renal disease during pregnancy that is not due to pre-eclampsia?

2 Answers available

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?

3 Answers available

What drives you to choose voclospsorin over tacrolimus given the substantially higher cost?

2 Answers available

How do you determine duration of therapy for patients who have responded well to voclosporin therapy?

How do you monitor response and what do you consider a satisfactory response? Do you aim for a certain threshold of proteinuria?

3 Answers available

When would you administer the next maintenance dose of rituximab in a patient with ANCA glomerulonephritis who last received an infusion six months ago and has low immunoglobulin levels and an undetectable CD-19 cell count?

1 Answer available

How do you approach discussing the pill burden of voclosporin with patients who already have to take a regimen such as MMF+HCQ+ACEi and possibly more?

2 Answers available

Are there patients with granulomatosis with polyangiitis on maintenance rituximab therapy for whom you do not co-administer glucocorticoid therapy?

1 Answer available

Do you extend the duration of maintenance therapy past 24 months for patients with ANCA glomerulonephritis who have multiple organ involvement?

2 Answers available

For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?

1 Answer available

In which patients with suspected IgA nephropathy and microalbuminuria would you recommend a kidney biopsy?

1 Answer available

What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?

2 Answers available

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

3 Answers available

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

3 Answers available

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

3 Answers available

When is a kidney biopsy warranted in a patient with possible scleroderma renal crisis?

1 Answer available

How do you think about biologic use in patients with underlying HIV infection?

2 Answers available

Papers discussed in this category

Arthritis and rheumatism, 2012-04

Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study.

Ann Rheum Dis, 2013 Jun 05

Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids.

Annals of the rheumatic diseases, 2021 Oct 06

B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial.

The New England journal of medicine, 2025 Feb 07

Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis.

Kidney international, 2019-01

A randomized, controlled double-blind study comparing the efficacy and safety of dose-ranging voclosporin with placebo in achieving remission in patients with active lupus nephritis.

N Engl J Med,

Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis.

Clinical journal of the American Society of Nephrology : CJASN, 2008-01

Value of a complete or partial remission in severe lupus nephritis.

Lancet, 2021 May 07

Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial.

Lancet (London, England), 2011 Feb 04

Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial.

Arthritis & rheumatology (Hoboken, N.J.), 2023 Jul 19

Safety and Efficacy of Long-Term Voclosporin Treatment for Lupus Nephritis in the Phase 3 AURORA 2 Clinical Trial.

Rheumatology international, 2017 Mar 03

Expanding the therapeutic options for renal involvement in lupus: eculizumab, available evidence.

Rheumatology (Oxford, England), 2015 Aug 27

Eculizumab as rescue therapy in severe resistant lupus nephritis.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2017 Mar-Apr

Biopsy of small kidneys: A safe and a useful guide to potentially treatable kidney disease.

Clinical journal of the American Society of Nephrology : CJASN, 2017 May 04

Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis.

BMC nephrology, 2019 Oct 31

Clinical practice guideline on pregnancy and renal disease.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2013 Jun 19

Severe lupus nephritis: the predictive value of a ≥ 50% reduction in proteinuria at 6 months.

Clinical journal of the American Society of Nephrology : CJASN, 2020 Mar 09

The Evolving Role of Calcineurin Inhibitors in Treating Lupus Nephritis.

Kidney international, 2021 Apr 18

A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy.

The New England journal of medicine, 2022 Nov 04

Empagliflozin in Patients with Chronic Kidney Disease.

Lupus science & medicine, 2020 Feb 18

Prediction of prognosis and renal outcome in lupus nephritis.

N Engl J Med, 2021 Feb 18

Avacopan for the Treatment of ANCA-Associated Vasculitis.

Lupus Sci Med, 2018

Serum albumin at 1 year predicts long-term renal outcome in lupus nephritis.

Annals of the rheumatic diseases, 2024 Jan 11

Rituximab as maintenance therapy for ANCA-associated vasculitides: pooled analysis and long-term outcome of 277 patients included in the MAINRITSAN trials.

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2012-08

Cyclophosphamide without corticosteroids for treatment of severe systemic necrotizing vasculitis.

Current medical research and opinion, 2016-12

Corticosteroids: the knee jerk response.

Cancer, 2006-09-15

Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero.

Journal of the National Medical Association, 1979 Feb

Administration of cyclophosphamide during late pregnancy and early lactation: a case report.

Annals of the rheumatic diseases, 2023 Oct 12

EULAR recommendations for the management of systemic lupus erythematosus: 2023 update.

Kidney international, 2024 Jan

KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS.

Lupus, 2023 Sep 27

Repeat kidney biopsy findings of lupus nephritis patients in clinical remission treated with Mycophenolate associated with Belimumab or Mycophenolate plus standard of care therapy. A "post-hoc" analysis of participants in the BLISS-LN and open label extension study belonging to a single center.

Arthritis Rheumatol, 2020 Aug 4

CALIBRATE: A Phase 2 Randomized Trial of Rituximab Plus Cyclophosphamide Followed by Belimumab for the Treatment of Lupus Nephritis.

Cureus, 2023 May 10

Treatment Using Both Voclosporin and Belimumab in Four Patients With Lupus Nephritis.

BMJ open, 2019 Dec 16

Belimumab after B cell depletion therapy in patients with systemic lupus erythematosus (BEAT Lupus) protocol: a prospective multicentre, double-blind, randomised, placebo-controlled, 52-week phase II clinical trial.

Annals of the rheumatic diseases, 2024 Oct 21

Efficacy and safety of sequential therapy with subcutaneous belimumab and one cycle of rituximab in patients with systemic lupus erythematosus: the phase 3, randomised, placebo-controlled BLISS-BELIEVE study.

Journal of the American Society of Nephrology : JASN, 2009-05

Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2011-12

The PROMISE study: a phase 2b multicenter study of voclosporin (ISA247) versus tacrolimus in de novo kidney transplantation.

Annals of internal medicine, 2015 Jan 06

Multitarget therapy for induction treatment of lupus nephritis: a randomized trial.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2003-07

Crescentic, proliferative IgA nephropathy: clinical and histological response to methylprednisolone and intravenous cyclophosphamide.

Arthritis and rheumatism, 2013-07

Vitamin D in systemic lupus erythematosus: modest association with disease activity and the urine protein-to-creatinine ratio.

Lupus,

Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis.

Arthritis care & research, 2023 Nov 28

Reference Range of Hydroxychloroquine Blood Levels That Can Reduce Odds of Active Lupus and Prevent Flares.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2023 Mar 31

The influence of repeated flares in response to therapy and prognosis in lupus nephritis.

Arthritis care & research, 2012-06

American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis.

Arthritis & rheumatology (Hoboken, N.J.), 2025 May 07

2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis.

Journal of clinical medicine, 2020 Aug 21

Glucocorticoids in . Ten Questions and Some Issues.

Autoimmunity reviews, 2017 May 28

Repeated pulses of methyl-prednisolone with reduced doses of prednisone improve the outcome of class III, IV and V lupus nephritis: An observational comparative study of the Lupus-Cruces and lupus-Bordeaux cohorts.

Lupus science & medicine, 2025 May 26

Long-term efficacy and safety of the Lupus-Cruces Nephritis protocol: a propensity score study of the Lupus-Cruces and Lupus-Bordeaux cohorts.

Medicine, 2017 Jul