{"doi":"10.2215/cjn.04530420","title":"How COVID-19 Has Changed the Management of Glomerular Diseases","abstract":"A 26-year-old woman contacted our office asking for an urgent call back. She had a history of steroid-dependent and frequently relapsing minimal change disease, and calls like this usually meant her home dipsticks had turned positive. Instead, she reported that she had just tested positive for the 2019 novel coronavirus (SARS-CoV-2 or COVID-19). She had a low-grade fever, myalgias, and a reduced sense of smell, but fortunately no cough or shortness of breath. She was worried about her dipsticks, however, which were still negative. What was usually a reassuring do-it-yourself test now frightened her. “Does that mean the rituximab is still in my system?” she asked, referring to the infusion she had done about 4 months earlier. As COVID-19 infections spread across the world, nephrologists and their patients face difficult decisions regarding management of glomerular diseases. Our Center for Glomerular Diseases has fielded countless questions in the last few weeks, not just from patients but from other nephrologists about the most appropriate way to handle immunosuppression in the current climate. Should lupus nephritis patients reduce their mycophenolate mofetil doses or stop the drug altogether? Should membranous nephropathy patients with rising titers of antibodies to the phospholipase A2 receptor (PLA2R) proceed with their scheduled rituximab infusions? Should severe ANCA-associated GN patients in the midst of an intravenous course of cyclophosphamide switch over to oral cyclophosphamide to avoid trips into the infusion center? Of course, there are no perfect, or even evidence-based, answers to these and other inquiries. Here, we offer some insight as to how our center in New York City, currently the world’s hottest spot for COVID-19 infections, has adapted the management of our glomerular disease patients to reduce complications of potential COVID-19 disease (Table 1). We also speculate on how our practice will be altered in the future, even at a time when, hopefully, COVID-19 infections are a thing of the past. Table 1. - Concise guidelines for management of glomerular disease patients during the COVID-19 pandemic (opinion-based) Component Recommendations Immunosuppression Discontinue antimetabolites for patients with confirmed or suspected infection Consider discontinuation of antimetabolites for patients in sustained remission >12 mo Favor short-acting, reversible agents over long-acting infusions Avoid therapy initiation for marginal criteria or nonstandard indications Avoid therapy initiation for minimally symptomatic patients with stable eGFR Convert intravenous infusions to oral formulation when possible (e.g., cyclophosphamide) and utilize home infusion services in lieu of hospital- or clinic-based infusion suites For patients in clinical trials with potential patient benefit, continue study drug by sending medication to their home if an oral or subcutaneous agent, or dosing in a COVID-19–compliant infusion center if an intravenous agent Diagnosis and monitoring Reserve biopsies for critical decision-making needs Consider empirical treatment, without biopsy, for conditions with high pretest probability diagnoses (e.g., RPGN with positive ANCA serologies) Limit blood draws to safety laboratories performed at commercial (i.e., non–hospital-based) laboratories Utilize home urine dipsticks for proteinuria monitoring Utilize commercially shipped collection kits for 24-h urine collections that can be done at home and shipped back Postpone protocol biopsies Supportive care Continue ACE inhibitors or ARBs in the absence of clear contraindications at this point Continue prophylactic antibiotics (e.g., TMP-SMX) Encourage social distancing Encourage use of masks while outside of the house Complete recommended vaccinations for influenza and pneumococcus (PCV13 and PPSV23) to prevent secondary or coinfection Office management Change all appointments to telemedicine video visits Allow office staff to manage phones and patient messa","journal":"Clinical Journal of the American Society of Nephrology","year":2020,"id":64681,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":27,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9559,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":240855,"name":"Pietro A. Canetta","orcid":"0000-0003-1130-5486","position":1,"is_corresponding":false},{"id":343284,"name":"Wooin Ahn","orcid":null,"position":2,"is_corresponding":false},{"id":240851,"name":"Syeda B. Ahmad","orcid":"0000-0002-5989-8877","position":3,"is_corresponding":false},{"id":237295,"name":"Jai Radhakrishnan","orcid":"0000-0003-3157-5141","position":4,"is_corresponding":false},{"id":244112,"name":"Gerald B. Appel","orcid":null,"position":5,"is_corresponding":false},{"id":242625,"name":"Andrew S. Bomback","orcid":"0000-0001-5449-1667","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-18T21:12:58.081635Z","pmid":"32332048","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}