Lupus Nephritis Clinical Trials, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Caus скачать в хорошем качестве

Lupus Nephritis Clinical Trials, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Caus

Four hospitalized patients with active lupus nephritis on various therapies present diverse clinical profiles-ranging from fluctuating kidney function and proteinuria to hypertension complications and infection risks. What clinical features and lab findings should inform your treatment strategy? How do randomized trial entry criteria influence therapeutic selections in these complex inpatients? VIDEO INFO Category: Lupus Nephritis Clinical Trials, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Expert - Expert level - For those seeking deep understanding Question Type: Management - Clinical management decisions Case Type: Multi Patient Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION Four inpatients with active systemic lupus erythematosus kidney disease are discussed on morning rounds in a US tertiary ward. The unit has ready access to mycophenolate mofetil (MMF), belimumab infusion, and voclosporin; obinutuzumab requires pharmacy pre-approval and negative infection screening.... OPTIONS A. Start voclosporin 23.7 mg twice daily with MMF titrated to 2 g/day and a rapid oral prednisone minimization ( =10 mg/day by weeks 10-12) in the 80-year-old with class IV-S, UPCR 2.1 g/g, eGFR 76 mL/min/1.73 m2, controlled blood pressure, and no active infection. B. Add belimumab IV 10 mg/kg at weeks 0, 2, and 4 then every 4 weeks for the patient with isolated class V, UPCR 0.8 g/g, and eGFR 92 mL/min/1.73 m2. C. Administer obinutuzumab 1000 mg on day 1, week 2, week 24, and week 26 with background azathioprine in the patient with shingles and absolute lymphocyte count 500/muL to achieve deep B-cell depletion before resuming MMF or altering steroids. D. Start tacrolimus 0.1 mg/kg/day divided with MMF 1 g/day and maintain prednisone 20 mg/day for 24 weeks in the patient with class IV-G, UPCR 3.7 g/g, eGFR 34 mL/min/1.73 m2, and frequent hyperkalemia on ACE inhibitor therapy. CORRECT ANSWER A. Start voclosporin 23.7 mg twice daily with MMF titrated to 2 g/day and a rapid oral prednisone minimization ( =10 mg/day by weeks 10-12) in the 80-year-old with class IV-S, UPCR 2.1 g/g, eGFR 76 mL/min/1.73 m2, controlled blood pressure, and no active infection. EXPLANATION Voclosporin-based triple therapy most closely mirrors AURORA-1 entry criteria and the steroid-minimization paradigm when baseline eGFR is above 45 mL/min/1.73 m2, proteinuria is at least 1.5 g/g for class III/IV, blood pressure and potassium are reasonably controlled, and there is no active infection. Patient A has class IV-S (A) with UPCR 2.1 g/g, eGFR 76, controlled blood pressure on ACEi/CCB, and no infection-an excellent fit for initiating a calcineurin inhibitor add-on with rapid prednisone minimization per KDIGO 2024 and ACR 2025. The remaining options misalign with trials or safety. Belimumab add-on for Patient B (pure class V, UPCR 0.8 g/g) does not reflect BLISS-LN populations (predominantly class III/IV +/- V and higher proteinuria); she also lacks a clear indication for escalation. Obinutuzumab for Patient C is inappropriate because of active varicella-zoster infection and lymphopenia, which are exclusionary for intensified B-cell-depleting therapy.... 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. ---------------------------------------------------