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?   

Few things are more complicated than lupus nephritis, and this question is not answered easily. It depends on hematuria, Cr, proteinuria, C3, C4, dsDNA, and systemic symptoms. So, it depends on what I think is causing the incomplete clinical response. If I believe it is the class V lesion, I would ...

I will agree with @Roger that this simple question is really quite complicated. I will try and be brief. This "triple-therapy" (i.e. MMF, VCS, and I presume steroids at some point in the treatment course) is quite appropriate for a mixed LN treatment. The idea of response must be considered in the c...

Dr. @Sarah El Chami: When we have a patient not achieving our response goals (eg, reduction of proteinuria by 25% at 3 months, 50% by 6 months, a urine protein: creatinine < 800 mg/mg by 1 year; plus no worsening of renal function), I consider several things: Adherence. I would monitor the ...

This is a complicated patient, but the simple answer here is—if they are not on an SGLT2i yet, then add SGLT2i (if there is no prior history of recurrent UTI). The next question to ask is whether there is still any immunologic component to this proteinuria, which needs evaluation for hematuri...