Therapeutic Interventions Guide, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Dia скачать в хорошем качестве

Therapeutic Interventions Guide, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Dia

A 28-year-old woman with chronic hepatitis B, a history of Graves disease, and biopsy-proven IgA nephropathy continues to have significant proteinuria after optimized ACE inhibitor and SGLT2 inhibitor therapy. She now wishes to avoid high-dose prednisone, and an alternative immunomodulator is being considered. Which complications should clinicians prioritize before initiating further immunosuppressive therapy in this complex clinical context? VIDEO INFO Category: Therapeutic Interventions Guide, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Hard - Advanced level - Challenges experienced practitioners Question Type: Complications Case Type: Typical Presentation Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 28-year-old woman with a history of Graves disease (previously on methimazole), prior Boerhaave syndrome repaired endoscopically, lateral epicondylitis, remote inguinal hernia repair, past Zika and CMV infections, and chronic hepatitis B (HBsAg positive; HBeAg negative; HBV DNA 2.3 x 10^5 IU/mL) presents to discuss disease-modifying therapy for proteinuric, biopsy-proven IgA nephropathy after 5 months of maximized ACE inhibitor and SGLT2 inhibitor therapy.... OPTIONS A. Hepatitis B virus reactivation; start antiviral prophylaxis with a high-barrier nucleos(t)ide-e.g., entecavir 0.5 mg orally once daily-at least 1 week before corticosteroid-based therapy and continue through treatment and for 6-12 months thereafter with HBV DNA and ALT monitoring. B. Pneumocystis jirovecii pneumonia; begin trimethoprim-sulfamethoxazole double-strength one tablet three times weekly prior to targeted-release budesonide as routine prophylaxis in all nontransplant glomerular disease patients. C. Latent tuberculosis reactivation; initiate isoniazid 300 mg orally daily with pyridoxine for 6-9 months before starting targeted-release budesonide in the absence of positive TB screening or epidemiologic risk. D. Severe hyperkalemia from combined SGLT2 inhibitor and ACE inhibitor; pre-emptively stop empagliflozin and lisinopril and substitute a loop diuretic before adding budesonide despite normal potassium and stable kidney function. CORRECT ANSWER A. Hepatitis B virus reactivation; start antiviral prophylaxis with a high-barrier nucleos(t)ide-e.g., entecavir 0.5 mg orally once daily-at least 1 week before corticosteroid-based therapy and continue through treatment and for 6-12 months thereafter with HBV DNA and ALT monitoring. EXPLANATION This HBsAg-positive patient with high-level viremia is about to start a corticosteroid-based regimen (targeted-release budesonide). Any systemic glucocorticoid exposure that is moderate to high or prolonged can trigger hepatitis B virus reactivation with potentially fulminant hepatitis. Contemporary hepatology guidance recommends initiating a high-barrier nucleos(t)ide-such as entecavir 0.5 mg orally once daily or tenofovir alafenamide-before immunosuppression, and continuing through treatment and for 6-12 months afterward with HBV DNA and ALT surveillance. In clinical practice, starting at least one week in advance ensures therapeutic levels before steroid exposure. Routine Pneumocystis prophylaxis is not indicated for all non-transplant glomerular patients receiving targeted-release budesonide alone; it is reserved for higher-dose systemic regimens or cytotoxic induction.... 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.