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Rheumatology

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Questions discussed in this category

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 treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?
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
What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?
For example, is captopril dialyzable? 
1 Answer 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
How do you counsel patients who experience diarrhea from mycophenolate mofetil (Cellcept)?
Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies? 
2 Answers available
Do you prefer using losartan in your patients with hypertension and gout due to its uricosuric effects?
2 Answers available
Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?
4 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
How would you approach management of a patient with ESRD on the transplant list who is found to have high titer APS labs (ACL, B2GP1, LAC)?
1 Answer available
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...
2 Answers available
Do you recommend uric acid lowering therapies for asymptomatic hyperuricemia in chronic kidney disease?
1 Answer available
What is your treatment approach when managing patients with relapsing lupus nephritis who previously achieved remission with mycophenolate and steroids?
5 Answers 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
If a patient who has tolerated allopurinol for a prolonged period of time is subsequently found to be positive for the HLA-B*58:01 gene, how would you manage urate-lowering therapy thereafter?
1 Answer available
Do you prefer allopurinol or febuxostat for patients with chronic kidney disease who are receiving treatment for asymptomatic hyperuricemia?
4 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
How would you approach pursuing a kidney biopsy in a patient with suspected lupus nephritis who is on warfarin for antiphospholipid antibody syndrome? 
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
What drives you to choose voclospsorin over tacrolimus given the substantially higher cost?
2 Answers available
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?
1 Answer available
Do you require lupus patients with ESKD or advanced CKD to be on minimal immunosuppression around the time of kidney transplantation?
1 Answer available
Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?
2 Answers available
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?
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
Do you recommend sending an autoimmune work up for patients with recurrent nephrolithiasis and 24 hour urine chemistries consistent with distal renal tubular acidosis?
1 Answer available
Do you prefer celecoxib over a nonselective NSAID in patients with chronic kidney disease?
4 Answers available
Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?
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
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?
1 Answer available
What is your approach to managing osteoporosis in patients with end stage kidney disease?
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 restrict topical diclofenac use in your patients with chronic kidney disease?
3 Answers available
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 ...
3 Answers available
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?
2 Answers available
In which patients with suspected IgA nephropathy and microalbuminuria would you recommend a kidney biopsy?
1 Answer available
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?
3 Answers 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
Do you avoid ESA use in patients with anemia and chronic kidney disease who also have APLS and risk for thrombosis?
2 Answers available
Would you add voclosporin to mycophenolate for refractory proteinuria in a patient with low EF?
Low EF in the range of 30%
1 Answer 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
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).
2 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
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?
3 Answers available
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.
1 Answer available
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.
1 Answer available
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?
1 Answer available
How do you approach treating mild hypercalcemia in patients with sarcoidosis?
1 Answer available
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?
3 Answers available
How would you manage tubulointerstitial nephritis and renal tubular acidosis (RTA) in a patient with Sjogren's who is pregnant?
2 Answers available
How do you treat sarcoidosis associated hypercalcemia in a patient with adenopathy and no other signs of systemic involvement?
1 Answer available
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)?
1 Answer available
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?
2 Answers available
When is a kidney biopsy warranted in a patient with possible scleroderma renal crisis?
1 Answer available
Do you routinely advise patients waiting for a kidney transplant to seek referrals at multiple institutions to decrease waiting time?
1 Answer available
What do you use for treatment induction in pure class V lupus nephritis with nephrotic-range proteinuria when MMF is contraindicated?
2 Answers available
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?
1 Answer available
How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?
1 Answer available
How do you use colchicine for gout in patients with chronic kidney disease or end-stage renal disease on hemodialysis?
2 Answers available
How do you approach treatment of osteoporosis in patients with CKD who develop a fragility fracture while on denosumab?
1 Answer available
How do you monitor a patient with scleroderma during pregnancy?
1 Answer available
What is your treatment algorithm for management of retroperitoneal fibrosis that does not respond to high-dose glucocorticoids?
1 Answer available
What is your approach to using NIH activity and chronicity indices from renal biopsy in tailoring immunosuppression to a patient with new lupus nephritis?
3 Answers available
How do you approach relapsing ANCA-associated vasculitis in a patient who has already undergone kidney transplant?
1 Answer available
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?
1 Answer available
How do you approach the management of immunosuppression in patients with lupus nephritis that go on to dialysis?
3 Answers available
How do you approach prophylaxis against glucocorticoid-induced osteoporosis in patients with end-stage renal disease on dialysis?
1 Answer available
Do you eventually stop urate-lowering therapy in gout patients with CKD who start hemodialysis?
1 Answer available
How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?
1 Answer available
How do steroids and/or DMARDs affect biopsy results if a renal biopsy for suspected lupus nephritis is delayed?
1 Answer available


Papers discussed in this category

N Engl J Med, 2020 Feb 13
Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis.
Ann. Rheum. Dis., 2018 Apr 25
Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2).
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.
Kidney international, 2009-12
A prospective study of protein excretion using short-interval timed urine collections in patients with lupus nephritis.
Clinical journal of the American Society of Nephrology : CJASN, 2010-07
Comparison of urinary albumin-creatinine ratio and albumin excretion rate in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study.
Journal of the American Society of Nephrology : JASN, 2010-08
Comparison of different measures of urinary protein excretion for prediction of renal events.
Am J Kidney Dis, 2016 Sep 16
Timed Urine Collections for Albumin and Protein: "The King Is Dead, Long Live the King!".
J Rheumatol, 2004 Aug
Urine protein-to-creatinine ratio is a reliable measure of proteinuria in lupus nephritis.
QJM, 2013 May 21
Targeting the endothelin axis in scleroderma renal crisis: rationale and feasibility.
The American journal of medicine, 1983-09
Prognostic factors in lupus nephritis. Contribution of renal histologic data.
Arthritis care & research, 2011-06
Predicting outcomes of lupus nephritis with tubulointerstitial inflammation and scarring.
Kidney international, 2018-04
Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices.
Kidney Int, 2010 Feb 24
Tubulointerstitial lesions of patients with lupus nephritis classified by the 2003 International Society of Nephrology and Renal Pathology Society system.
AACE Clin Case Rep, 2020 Aug 06
METHOTREXATE TREATMENT FOR SARCOIDOSIS-INDUCED HYPERCALCEMIA.
Am J Med, 1987 Jun
Hydroxychloroquine treatment of hypercalcemia in a patient with sarcoidosis undergoing hemodialysis.
Sarcoidosis Vasc Diffuse Lung Dis, 2012 Mar
Hypercalcemia from sarcoidosis successfully treated with infliximab.
Arch Osteoporos, 2017 Jul 19
Glucocorticoid sparing effect of zoledronic acid in sarcoid hypercalcemia.
BMJ Case Rep, 2022 Jul 08
Hungry bone syndrome like presentation following single-dose denosumab for hypercalcaemia secondary to sarcoidosis with IgA nephropathy.
Arthritis Res Ther, 2014 Mar 24
Bone fragility in sarcoidosis and relationships with calcium metabolism disorders: a cross sectional study on 142 patients.
Kidney Int Rep, 2020 Mar 16
Spondyloarthritis-Associated IgA Nephropathy.
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.
Nat Rev Nephrol, 2015 Nov 16
Renal involvement in primary Sjögren syndrome.
J Rheumatol, 2017 May 15
Longterm Hydroxychloroquine Therapy and Low-dose Aspirin May Have an Additive Effectiveness in the Primary Prevention of Cardiovascular Events in Patients with Systemic Lupus Erythematosus.
Annals of clinical and laboratory science, 2008
Nephrotic range proteinuria: rare manifestation of scleroderma renal crisis.
International journal of general medicine, 2019 Sep 02
Renal pathology and clinical associations in systemic sclerosis: a historical cohort study.
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.
Ann Rheum Dis, 2020 Jan
The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease.
Seminars in arthritis and rheumatism, 2016 Sep 21
The utility of lupus serology in predicting outcomes of renal transplantation in lupus patients: Systematic literature review and analysis of the Toronto lupus cohort.
Clinical rheumatology, 2018 May 11
Impact of pre-transplant time on dialysis on survival in patients with lupus nephritis.
Arthritis and rheumatism, 2011-12
A phase III, randomized, placebo-controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus.
Lupus,
Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis.
Arthritis Rheumatol, 2017 Apr 07
Efficacy and Safety of Subcutaneous Belimumab in Systemic Lupus Erythematosus: A Fifty-Two-Week Randomized, Double-Blind, Placebo-Controlled Study.
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.
Current opinion in rheumatology, 2018 Jul
Trimethoprim-sulfamethoxazole and antineutrophil cytoplasmic antibodies-associated vasculitis.
European journal of medical research, 2009 Dec 07
Co-trimoxazole and prevention of relapses of PR3-ANCA positive vasculitis with pulmonary involvement.
Annals of the rheumatic diseases, 2018 Jun 27
Trimethoprim-sulfamethoxazole prophylaxis prevents severe/life-threatening infections following rituximab in antineutrophil cytoplasm antibody-associated vasculitis.
Rheumatic diseases clinics of North America, 2006 Feb
Abetimus sodium (riquent) for the prevention of nephritic flares in patients with systemic lupus erythematosus.
The New England journal of medicine, 1986 Mar 06
Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs.
BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy, 2003
Abetimus: Abetimus sodium, LJP 394.
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.
Therapeutic drug monitoring, 2022 Jun 01
Drug-Drug Interactions Between Mycophenolic Acid and Proton Pump Inhibitors: A Systematic Review and Meta-Analysis.
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.
The New England journal of medicine, 2018-03-29
Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout.
Lancet, 2020 Nov 09
Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2019 Jan 17
Update on the Native Kidney Biopsy: Core Curriculum 2019.
Nephrology (Carlton, Vic.), 2019 Oct 23
KHA-CARI Guideline recommendations for renal biopsy.
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.
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, 2012-10
2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia.
Proceedings of the National Academy of Sciences of the United States of America, 2005 Mar 02
HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol.
Clinical transplantation, 2020 Nov 22
Hydroxychloroquine and maintenance immunosuppression use in kidney transplant recipients: Analysis of linked US registry and claims data.

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