Therapeutic Immunosuppression, Pauci-Immune Glomerulonephritis (GN), Glomerulonephritis: Causes, Dia скачать в хорошем качестве

Therapeutic Immunosuppression, Pauci-Immune Glomerulonephritis (GN), Glomerulonephritis: Causes, Dia

A 56-year-old man presents with weeks of dark urine, fatigue, kidney injury, and abnormal urinalysis, on a background of diabetes, HIV, sleep apnea, and past vasculitis. Kidney biopsy finds necrotizing and crescentic glomerular lesions without immune deposits. As he prepares for immunosuppressive therapy, what clinical actions minimize preventable complications in this scenario? Which factors drive patient safety and guide pre-treatment precautions in such complex nephrology cases? VIDEO INFO Category: Therapeutic Immunosuppression, Pauci-Immune Glomerulonephritis (GN), Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Expert - Expert level - For those seeking deep understanding Question Type: Legal Pitfalls Case Type: Typical Presentation Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 56-year-old man (84 kg, 175 cm) is evaluated for 3 weeks of dark urine, progressive fatigue, and intermittent pleuritic chest discomfort. He denies hemoptysis. Past history includes type 2 diabetes with albuminuria, HIV infection with sustained viral suppression, obstructive sleep apnea on nighttime CPAP, paroxysmal supraventricular tachycardia, and a remote small-vessel cutaneous vasculitis episode 5 years ago without renal involvement. Family history is noncontributory.... OPTIONS A. Start and document hepatitis B prophylaxis before B-cell depletion: initiate a nucleos(t)ide with high barrier to resistance (for example, entecavir 0.5 mg PO daily or tenofovir disoproxil fumarate 300 mg PO daily or tenofovir alafenamide 25 mg PO daily), obtain baseline HBV DNA and ALT/AST today... B. Defer antiviral prophylaxis because HBsAg is negative; proceed with rituximab now and document a plan to check ALT and HBV DNA every 1-3 months, starting antivirals only if HBV DNA becomes detectable or ALT rises, while starting TMP-SMX prophylaxis today and revisiting hepatology input next week. C. Rely on the anti-HBs level; order a quantitative anti-HBs today and, if =10 IU/L, document that existing antibody indicates adequate protection so that no prophylactic antiviral is needed; monitor HBV DNA during rituximab without any post-therapy antiviral tail and proceed with TMP-SMX prophylaxis. D. Alter induction to avoid B-cell depletion: switch to IV cyclophosphamide 15 mg/kg every 2-3 weeks with a standard-dose prednisone taper, document preemptive monthly HBV DNA/ALT monitoring instead of prophylaxis, and proceed today without initiating antivirals because the reactivation hazard is pr... CORRECT ANSWER A. Start and document hepatitis B prophylaxis before B-cell depletion: initiate a nucleos(t)ide with high barrier to resistance (for example, entecavir 0.5 mg PO daily or tenofovir disoproxil fumarate 300 mg PO daily or tenofovir alafenamide 25 mg PO daily), obtain baseline HBV DNA and ALT/AST today, and specify q1-3-month HBV DNA/LFT monitoring during rituximab and for at least 12 months after the last dose; begin TMP-SMX Pneumocystis prophylaxis and record informed consent describing reactivation and infection risks. EXPLANATION In this patient with biopsy-proven pauci-immune, PR3-ANCA glomerulonephritis who is scheduled for rituximab, the single action that most directly reduces medicolegal exposure for a predictable and preventable complication is to start and document hepatitis B prophylaxis before B-cell depletion, coupled with baseline HBV DNA and ALT/AST today and a stand... 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 advi...