Rheumatology&nbsp;&nbsp;&nbsp;

How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?

What is your approach to managing osteoporosis in patients with end stage kidney disease?

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

Do you restrict topical diclofenac use in your patients with chronic kidney disease?

What is your approach to nephrology referral for patients with lupus nephritis?

Do you refer all patients with suspected LN, patients with confirmed LN, or patients with specific features (not responding to usual therapy, certain ...

What is your approach to a patient with IgG4RD with past pulmonary involvement (biopsy proven) managed with steroids alone, now with new hematuria/proteinuria, but stable renal function?

Would you obtain renal biopsy first or treat with additional immunosuppression for suspected renal involvement related to IgG4?

4 Answers available

What is the approach to use of ACE inhibitors for suspected scleroderma renal crisis in patients with only mildly elevated BP and renal artery stenosis?

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

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?

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)?

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

Do you avoid ESA use in patients with anemia and chronic kidney disease who also have APLS and risk for thrombosis?

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

Low EF in the range of 30%

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

Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

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?

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

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.

How do you manage patients with systemic sclerosis and chronic thrombotic microangiopathy on renal biopsy, but no other evidence of scleroderma renal crisis?

Patient with nephrotic range proteinuria, but there is no evidence of active TMA on renal biopsy.

How do you approach urate-lowering therapy in patients with advanced chronic kidney disease?

What doses of allopurinol do you use, and how frequently do you titrate the dose?

How do you approach treating mild hypercalcemia in patients with sarcoidosis?

Do you recommend starting aspirin for a patient with ESKD secondary to lupus nephritis with detected antiphospholipid antibodies on pretransplant workup but no history of a thrombotic event?

How would you manage tubulointerstitial nephritis and renal tubular acidosis (RTA) in a patient with Sjogren's who is pregnant?

How do you treat sarcoidosis associated hypercalcemia in a patient with adenopathy and no other signs of systemic involvement?

How would you manage a patient with osteoporosis on denosumab who develops significant renal insufficiency where it is difficult to continue denosumab due to increased risk of hypocalcemia (i.e. eGFR in the low 20’s)?

How would you manage a patient with stable axial spondyloarthritis who develops newly active IgA nephropathy?

Is there a role for immunosuppressive medications such as TNF inhibitors in the management of IgA nephropathy in this setting?

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

Do you routinely advise patients waiting for a kidney transplant to seek referrals at multiple institutions to decrease waiting time?

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?

How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?

How do you use colchicine for gout in patients with chronic kidney disease or end-stage renal disease on hemodialysis?

How do you approach treatment of osteoporosis in patients with CKD who develop a fragility fracture while on denosumab?

How do you monitor a patient with scleroderma during pregnancy?

What is your treatment algorithm for management of retroperitoneal fibrosis that does not respond to high-dose glucocorticoids?

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 relapsing ANCA-associated vasculitis in a patient who has already undergone kidney transplant?

How do you approach the use of endothelin receptor antagonists in patients with scleroderma renal crisis and hypertension refractory to maximum ACE inhibition and calcium channel blockers?

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

How do you approach prophylaxis against glucocorticoid-induced osteoporosis in patients with end-stage renal disease on dialysis?

Do you eventually stop urate-lowering therapy in gout patients with CKD who start hemodialysis?

How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?

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

Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?