Chronic Kidney Disease Progression, Pauci-Immune Glomerulonephritis (GN), Glomerulonephritis: Causes скачать в хорошем качестве

Chronic Kidney Disease Progression, Pauci-Immune Glomerulonephritis (GN), Glomerulonephritis: Causes

A 74-year-old man with a history of pauci-immune crescentic glomerulonephritis in remission presents for routine follow-up, now with persistent albuminuria and stage G3b chronic kidney disease. Home blood pressure is well controlled, and his ANCA and complements are normal. What additional findings in his presentation and labs highlight ongoing risk for kidney decline? Which clinical considerations should help guide optimal management to slow CKD progression? VIDEO INFO Category: Chronic Kidney Disease Progression, Pauci-Immune Glomerulonephritis (GN), Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Moderate - Intermediate level - Requires solid foundational knowledge Question Type: Prevention - Preventive measures and screening Case Type: Typical Presentation Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 74-year-old man with a history of pauci-immune crescentic glomerulonephritis diagnosed 18 months ago by native kidney biopsy presents to nephrology clinic for routine follow-up. He is in clinical remission after rituximab-based induction and received a single 500 mg maintenance rituximab infusion 8 months ago. Past medical history includes cholangitis treated 10 years ago, recurrent otitis externa in his 60s, and normal pressure hydrocephalus managed conservatively.... OPTIONS A. Initiate an SGLT2 inhibitor for CKD with albuminuria-start dapagliflozin 10 mg orally once daily now, continue lisinopril and titrate blood pressure toward a standardized office systolic target under 120 mm Hg as tolerated, with counseling on sodium intake under 2 g/day and sick-day medication ho... B. Add finerenone 10 mg orally once daily in addition to lisinopril to reduce albuminuria, without starting an SGLT2 inhibitor, and keep the current systolic blood pressure goal near 130-135 mm Hg. C. Begin high-dose oral prednisone at 1 mg/kg daily for three months to suppress subclinical vasculitis activity, then taper slowly, deferring changes to his antihypertensives and diet. D. Start dual renin-angiotensin blockade by adding losartan 50 mg orally nightly to ongoing lisinopril, maintain current diet, and avoid SGLT2 inhibitors because his eGFR is below 45 mL/min/1.73 m2. CORRECT ANSWER A. Initiate an SGLT2 inhibitor for CKD with albuminuria-start dapagliflozin 10 mg orally once daily now, continue lisinopril and titrate blood pressure toward a standardized office systolic target under 120 mm Hg as tolerated, with counseling on sodium intake under 2 g/day and sick-day medication holds. EXPLANATION "Initiate an SGLT2 inhibitor for CKD with albuminuria-start dapagliflozin 10 mg orally once daily now, continue lisinopril and titrate blood pressure toward a standardized office systolic target under 120 mm Hg as tolerated, with counseling on sodium intake under 2 g/day and sick-day medication holds." This is correct because, in adults with albuminuric CKD (A3) and eGFR in the mid-30s, SGLT2 inhibitors slow eGFR decline and reduce progression to kidney failure independent of diabetes status. Adding an SGLT2 inhibitor to ongoing ACE inhibitor therapy targets complementary pathways: glomerular hemodynamics via tubuloglomerular feedback and intrarenal anti-inflammatory, antifibrotic effects.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------