Glomerular Disease Clinical Case Review

In this video, Craig Gordon, MD, nephrologist at Tufts Medical Center and associate professor of medicine at Tufts University School of Medicine, goes over the results and discusses this case of lupus nephritis:

Editor’s note: The following is an automatically generated transcript of the above video.

"Pleased to report that almost six months into this course, she's had a very nice response. Her proteinuria has improved from a peak of around 12.6 grams to recently, a few weeks ago, down to 1.9 grams, with a concomitant improvement in her serum albumin to 3.8 grams per deciliter. Her eGFR has been stable, the most recent value of 89 MLs per minute. Her complement values have returned to normal and double-stranded DNA have normalized as well. So she continues at the present time on full-dose mycophenolate and voclosporin (Lupkynis, Aurinia). We've nearly completely tapered her off prednisone and expect to do so in the next few weeks.

As we approach the six-month mark, we're starting to consider a change from induction therapy to the maintenance therapy of lupus. And probably in the next few months we'll begin the process of tapering down the anti-metabolite. She's currently taking an ARB. And at the most recent visit we started an SGLT2 inhibitor to see if the combination plus just more time for the action of the anti-metabolite and calcineurin inhibitor to achieve further lowering of the proteinuria will occur. I think, as I alluded to in the last slide, it's perhaps too early to determine how much additional improvement in the proteinuria will occur.

I think this would currently be considered a partial response but I think it wouldn't surprise me at all in the next three to six months if we see a even further decline in the level of proteinuria with the above changes, with a plan to continue the calcineurin inhibitor for at least somewhere in the order of two to perhaps up to three years based on some of the previous studies and data from these. And I think with that I will conclude. So thank you for your attention. I appreciate your time."