Director's Cut
A biopsy shows mesangial immune-complex deposits on immunofluorescence with normal light microscopy. This ISN/RPS class is the renal equivalent of “the lesion is technically there, but it is being subtle
What is class I lupus nephritis?
These two serum complement components are commonly reduced during immunologically active lupus nephritis, although normal values do not exclude active disease.
What are C3 and C4?
In active class III/IV lupus nephritis, this agent should generally be initiated and continued unless contraindicated, even though it is not the main induction immunosuppressant.
What is hydroxychloroquine?
This athlete’s name is also a common way fellows describe a urine protein-creatinine ratio that remains persistently elevated despite three medication changes and two group chats.
What is LeBron?
Accept: What is “still not going down”?
In patients with lupus nephritis and any elevation in proteinuria, this kidney-protective medication strategy is recommended unless contraindicated.
What is renin-angiotensin-aldosterone system inhibition?
A biopsy with endocapillary hypercellularity, subendothelial immune deposits, and active lesions in 35% of glomeruli is assigned this class.
What is class III lupus nephritis?
This antibody may rise before or during a lupus nephritis flare, but its imperfect correlation with histologic activity makes isolated treatment escalation a questionable strategy.
What is anti-double-stranded DNA antibody?
The three broad components of current triple immunosuppressive treatment for active class III/IV lupus nephritis are glucocorticoids plus two additional therapies. This medication class is the backbone of two commonly recommended combinations.
What are mycophenolic acid analogs?
A patient with established lupus nephritis develops increased creatinine after starting an NSAID, without active sediment or increased proteinuria. This alternative explanation should be considered before reflexively intensifying immunosuppression.
What is medication-induced kidney injury?
This complication should be considered in a patient with severe nephrotic syndrome, marked hypoalbuminemia, antiphospholipid antibodies, or other thrombotic risk factors.
What is venous thromboembolism?
This television medical drama shares its title with the preferred environmental condition for a lupus patient who is avoiding ultraviolet-triggered photosensitivity.
What is “House”?
Accept: What is staying indoors?
This urinary sediment finding, particularly when dysmorphic or accompanied by red blood cell casts, supports glomerular hematuria.
What are acanthocytes?
In active class III/IV lupus nephritis with substantial extra-renal lupus manifestations, triple therapy containing this B-cell survival factor inhibitor may be favored over a calcineurin inhibitor-containing regimen.
Response:
What is belimumab?
In a treated patient with worsening proteinuria, hematuria, or kidney function after at least 6 months of appropriate therapy, this procedure can distinguish persistent active nephritis from chronic damage, class transition, or another diagnosis.
What is a repeat percutaneous kidney biopsy?
When kidney biopsy is not feasible and a patient has nephritic features such as hematuria, hypertension, and impaired kidney function, management is generally aligned with this lupus nephritis category.
What is class III/IV lupus nephritis?
This active lesion receives extra weight in the modified NIH activity index because it is strongly associated with severe injury and poor renal outcomes.
What is fibrinoid necrosis?
In basketball, this position protects the rim. In nephrology, this cell type protects the glomerular filtration barrier and becomes central to the diagnosis of lupus podocytopathy.
What is a podocyte?
For class III/IV lupus nephritis with proteinuria of at least 3 g/g, triple therapy using a mycophenolic acid analog plus this medication class is conditionally favored over a belimumab-containing regimen.
What is a calcineurin inhibitor?
A patient with SLE, acute kidney injury, hypertension, thrombocytopenia, hemolytic anemia, and biopsy evidence of arteriolar thrombi may have this renal vascular process rather than immune-complex activity alone.
What is thrombotic microangiopathy?
This renal replacement modality is generally preferred over chronic dialysis for patients with lupus nephritis who progress to end-stage kidney disease.
What is kidney transplantation?
A patient with SLE has nephrotic-range proteinuria, bland urine sediment, normal complement, and a biopsy with diffuse foot-process effacement but no significant immune-complex deposits. This lupus-associated entity should be considered rather than assuming pure class V disease.
What is lupus podocytopathy?
In Star Wars, this force binds the galaxy together. In lupus nephritis, this similarly named system binds immune complexes, triggers inflammation, and causes fellows to order C3 and C4 at approximately every visit.
What is the complement system?
This low-dose intravenous cyclophosphamide protocol consists of 500 mg every 2 weeks for a total of six doses and is preferred over daily oral cyclophosphamide when cyclophosphamide is selected.
What is the Euro-Lupus cyclophosphamide regimen?
A patient with prior pure class V lupus nephritis develops new red blood cell casts, declining eGFR, and hypocomplementemia. The most concerning explanation is histologic transformation to this higher-risk lesion category.
What is proliferative lupus nephritis, class III or IV?
This is the most appropriate response when nephrology says, “Could you please order urine electrolytes, renal ultrasound, hemolysis labs, antiphospholipid antibodies, infection testing, medication reconciliation, and a kidney biopsy before we discuss the case?”
What is “Absolutely, thank you for your partnership”?