General Internal Medicine

Glomerulonephritis

Questions discussed in this category

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

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

6 Answers available

Do you use delayed-release budesonide over prednisone or methylprednisolone for the treatment of IgA nephropathy, considering the available safety and efficacy data?

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

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

What are some indications that might lead you to pursue a kidney biopsy in a patient with presumed diabetic kidney disease?

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

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

1 Answer available

Do you prefer starting a SGLT2i before steroids in patients with IgA nephropathy and proteinuria > 1.0 gram/day who are unable to tolerate ACEi/ARB due to hypotension?

1 Answer available

What is your approach to immunosuppression in patients with preserved kidney function who are found to have nephrotic syndrome of unknown etiology and cannot safely undergo a kidney biopsy?

1 Answer available

Are there instances when you would recommend obtaining a 24 hour urine protein measurement in place of spot urine protein studies in patients with acute kidney injury and proteinuria?

2 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

Would you recommend genetic testing to determine if there is a potential underlying primary process in a patient with congenital solitary kidney who is presumed to have secondary FSGS?

1 Answer available

What instances will you start outpatient steroids in patients with nephrotic syndrome of unknown etiology prior to obtaining a kidney biopsy?

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

Do you pursue a skin biopsy or kidney biopsy in patients whom you suspect have X-linked Alport syndrome?

2 Answers 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

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

5 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

Are there instances when you would pursue a kidney biopsy in a pregnant patient instead of waiting to perform the procedure post-delivery?

2 Answers available

Would you recommend mycophenolate mofetil for patients with progressive IgA nephropathy who do not tolerate corticosteroids?

Based on the results of the MAIN trial; Hou et al., PMID: 36745456

2 Answers available

Is there a kidney length for which you would no longer recommend attempting a kidney biopsy due to safety concerns and lack of diagnostic yield?

1 Answer available

Do you recommend a kidney biopsy in a patient with myelodysplastic syndrome diagnosed two years prior who develops new onset proteinuria?

1 Answer available

What is your approach to patients with membranous glomerulonephritis who have persistently elevated PLA2R titers but largely improved proteinuria and creatinine?

1 Answer available

Do you recommend obtaining a vasculitis work up for all patients seen for chronic kidney disease who are without a kidney biopsy?

1 Answer available

Are there cases of glomerulonephritis where you do not perform a kidney biopsy in a patient deemed safe to undergo the procedure?

1 Answer available

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

1 Answer available

Papers discussed in this category

Journal of the American Society of Nephrology : JASN, 2017-02

A Proposal for a Serology-Based Approach to Membranous Nephropathy.

Kidney international reports, 2021 Jan 06

Spectrum of Kidney Involvement in Patients with Myelodysplastic Syndromes.

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.

Pediatric nephrology (Berlin, Germany), 2020 Nov 06

Clinical practice recommendations for the diagnosis and management of Alport syndrome in children, adolescents, and young adults-an update for 2020.

The Journal of molecular diagnostics : JMD, 2012 Aug 21

Skin biopsy is a practical approach for the clinical diagnosis and molecular genetic analysis of X-linked Alport's syndrome.

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.

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.

Related Topics in General Internal Medicine