Lupus Nephritis Clinical Trials, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Caus

Описание: A 20-year-old woman with a new diagnosis of lupus nephritis and a history of childhood bladder cancer, hypertrophic cardiomyopathy, and multiple allergies is preparing to start an add-on therapy clinical trial. With her current immunosuppressive regimen and complex past medical background, what steps should you consider before enrollment to minimize infectious risk? How can her risk factors and medication history inform your decision-making during evaluation for trial participation?

VIDEO INFO
Category: Lupus Nephritis Clinical Trials, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management
Difficulty: Easy - Basic level - Suitable for medical students
Question Type: Prevention - Preventive measures and screening
Case Type: Typical Presentation

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QUESTION
A 20-year-old woman with newly diagnosed lupus nephritis (ISN/RPS class III on biopsy) presents for counseling before joining an add-on therapy trial. Vitals: pulse 59 bpm, temperature 31.7 degreesC after walking in from freezing weather (quickly rewarmed; afebrile on repeat), respirations 22/min, blood pressure 110/55 mm Hg, oxygen saturation 100% on room air....

OPTIONS
A. Update inactivated influenza and pneumococcal vaccines and verify hepatitis B immunity before randomization; avoid live vaccines after induction begins; document timing per CDC guidance.
B. Administer live-attenuated zoster vaccine today for rapid protection, then start trial drugs within 24 hours to avoid delaying induction therapy.
C. Give a 14-day course of broad-spectrum oral antibiotics to all participants after randomization to offset early pneumonia risk observed in prior trials.
D. Defer all immunizations until after completion of induction therapy to prevent adverse-event attribution confounding during the first 3 months.

CORRECT ANSWER
A. Update inactivated influenza and pneumococcal vaccines and verify hepatitis B immunity before randomization; avoid live vaccines after induction begins; document timing per CDC guidance.

EXPLANATION
The correct answer is "Update inactivated influenza and pneumococcal vaccines and verify hepatitis B immunity before randomization; avoid live vaccines after induction begins; document timing per CDC guidance." Before intensifying immunosuppression for LN, ensure inactivated vaccines are up to date and hepatitis B immunity is verified, aligning with CDC recommendations and KDIGO 2024. Recombinant zoster vaccine is preferred when age-eligible and immunocompromised. Live vaccines should be avoided after induction starts. This 20-year-old on MMF, prednisone, and hydroxychloroquine is at increased infection risk; pre-trial vaccination reduces preventable early pneumonia and other infections.

"Administer live-attenuated zoster vaccine today..." is incorrect; live zoster is contraindicated with imminent or ongoing immunosuppression, whereas recombinant zoster is non-live. "Give a 14-day course of broad-spectrum oral antibiotics to all participants..." is incorrect due to antimicrobial stewardship concerns and lack of evidence....


Further reading:

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