Thread by @kidney_boy

Brad Rovin from The Ohio State University. Hmm are they in the #FrozenFour? No. No they re not #GoBlue #NKFClinicals

Brad is a fill in for Samir Parik
He has massive COI all over the place. Every drug. Every company. #NKFClinicals

Starts out with a case. Cr up from 0.6 to 1.2. 3500 mg of protein. Biopsy is WHO 4 and 5. She does not respond to MMF and steroids. Then does not respond to CYT. What to do?

Beware of getting on the roulette wheel of immunosuppression

An operational definition of refractory lupus nephritis.

Less than 20% of people are taking the drugs at 12 months. This is a huge problem. #NKFClinicals

HCQ levels are particularly useful. HCQ has along half live, 7-40 days so a low or zero level cannot be attributed to forgetting a dose. Similarly, just taking the drug before going to the doctor will not result in a therapeutic level. #NKFClinicals

Improve adherence. Good luck. Cost reduction with belimumab and voclosporin 🤣 #NKFClinicals

Be patient it takes several months to get response. Late response is possible. But should see some movement (25% reduction in proteinuria) in 2-3 months. #NKFClinicals

🚨 EXPERT OPINION 🚨 #NKFClinicals

He just described the KDIGO guidelines that came out last fall as “In the old days” #NKFClinicals

The new therapies (voclosporin and belimumab) did not test on refractory lupus. But there are post-how analysis…one interpretation is best response to people with prior immunosuppression exposure. #NKFClinicals

The best data for rescue therapy is with rituximab. After that…welcome to the Wild West. All kinds of things have been tried from CASR-T to stem cell to leflunomide, anti-IL-2, etc. #NKFClinicals

Intensive B-Cell depletion. Impressive, but N=12 #NKFClinicals

Back to the case. Patient went for repeat biopsy and turned out immunocompromised were gone and she now had TMA from antiphospholipid antibody syndrome. #NKFClinicals

Summary slide