Lupus nephritis&nbsp;&nbsp;&nbsp;

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?

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...

How would you approach potentially tapering maintenance mycophenolate mofetil in a patient with a history of class IV LN that has been in remission for >5 years?

The case prompting the question is a female in her late teens who was diagnosed with Class IV LN at her prepubescent age and was treated with HCQ and ...

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

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?

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

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?

What is your preferred add-on for membranous lupus nephritis (2.2 grams of protein, normal creatinine) in a young woman who is currently on hydroxychloroquine and mycophenolate 1500 mg 2x daily?

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?

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?

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?

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 ...

Do you choose rituximab or calcineurin inhibitors for patients with class IV/V lupus nephritis who are refractory to standard of care therapies?

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?

Is there a role for voclosporin in non-renal lupus?

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

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

Is there a role for measuring serum mycophenolate mofetil levels (or its active metabolite) in the management of lupus nephritis?

Do you routinely monitor the QTc when adding voclosporin to hydroxychloroquine in a patient with lupus nephritis?

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 do you approach recurrent costochondritis in an SLE patient with nephritis who is otherwise controlled on MMF and HCQ but can't take NSAIDs?

How would you approach the treatment of a patient who, during a hospitalization, was initially diagnosed with TTP and treated with PLEX with good response, but renal biopsy then resulted class IV LN along with changes of thrombotic microangiopathy?

4 Answers available

How would you treat a patient with active lupus nephritis (class 3/4) who requires PD-1 immunotherapy for refractory metastatic renal cell carcinoma?

In patients with lupus nephritis on maintenance therapy, is there additional benefit in utilizing 2 grams vs 3 grams of mycophenolate mofetil (MMF) daily?

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

Would you consider adding voclosporin to belimumab and MMF in the setting of active proteinuria, rather than switching agents?

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

Do you think there is a role for belimumab in treating lupus nephritis and if so, in which patients would you considering adding it on?

Did the recently published BLISS-LN trial change your practice?

What is your approach to bladder cancer surveillance in patients who have received cyclophosphamide?

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

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