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

A 30-year-old man with a history of SLE, recent anasarca and refractory edema, and new-onset heavy proteinuria presents a complex diagnostic and management challenge. Considering the absence of gross hematuria, prior pleural effusions, and current immunosuppressive therapies, what clinical features and laboratory results best inform your next steps for targeting the underlying nephrotic process? VIDEO INFO Category: Lupus Nephritis Clinical Trials, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Hard - Advanced level - Challenges experienced practitioners Question Type: Treatment Failure Case Type: Rare Presentation Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 30-year-old man (vegetarian, soy allergy with urticaria) with SLE presents with 6 weeks of anasarca, refractory edema, and new heavy proteinuria. Vitals: pulse 129, temperature 37.6 degreesC, respirations 13, blood pressure 120/palpable, SpO2 87% on room air.... OPTIONS A. Add voclosporin 23.7 mg twice daily to mycophenolate 2 g/day with a rapid, protocolized steroid taper, targeting UPCR =0.5 g/g by 52 weeks, while monitoring eGFR and potassium every 2-4 weeks. B. Add belimumab IV 10 mg/kg at weeks 0, 2, and 4 then every 4 weeks while reducing mycophenolate to 1 g/day to limit cytopenias and maintain prednisone 20 mg/day through week 24 for nephrotic control. C. Administer rituximab 1,000 mg IV on days 1 and 15 and stop mycophenolate to prevent overlapping immunosuppression, deferring any calcineurin inhibitor until after a second biopsy confirms remission. D. Increase prednisone to 1 mg/kg/day for 12 weeks without any adjunct, deferring all steroid-sparing agents until albumin normalizes and edema resolves on loop diuretics and ACE inhibitor therapy. CORRECT ANSWER A. Add voclosporin 23.7 mg twice daily to mycophenolate 2 g/day with a rapid, protocolized steroid taper, targeting UPCR =0.5 g/g by 52 weeks, while monitoring eGFR and potassium every 2-4 weeks. EXPLANATION This patient has pure class V membranous LN with nephrotic-range proteinuria (UPCR 6.2 g/g), preserved eGFR 83 mL/min/1.73 m2, and EM showing segmental foot-process effacement. For heavy proteinuria with preserved kidney function, voclosporin layered on MMF with a rapid, protocolized steroid taper achieves faster antiproteinuric effects while meeting AURORA-1 entry criteria (eGFR =45; higher UPCR thresholds for pure V). Adding voclosporin 23.7 mg twice daily to MMF 2 g/day and tapering prednisone rapidly, with monitoring of eGFR and potassium, best targets the dominant nephrotic physiology. Belimumab improves composite renal outcomes but is slower for nephrotic control and should not prompt down-titration of MMF nor prolonged prednisone at 20 mg/day. Rituximab monotherapy with MMF cessation is unsupported for upfront class V LN, and deferring CNIs until a second biopsy delays an agent with proven antiproteinuric efficacy.... 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. ---------------------------------------------------