Most likely CYC as Rituximab has not done so hot in SLE. However, more info on the patient will be helpful: age? Comorbidities? Baseline and peak creatinine? and some data from the biopsy: percent crescents, type of crescent (fibros, cellular, or fibro cellular) and %IFTA

TINU?

Systemic steroids can definitely cover all of these potential etiologies (IBD, TNF or even AIN). However, with more targted treatments available (like targeted release budesonide) coming up with clinical criteria to make the precise diagnosis will become more and more important

@jzrenlapath.bsky.social are there any histological features to help distinguish IgAN associated with tnf-i from those associated with IBD itself? The distinction can have huge implications in terms of treating IBD.

The biggest issue (and the reason for failure) was that it was actually not approved in pre-dialysis patients (and as far as I remember, not even for PD patients) to begin with...

Looks like amyloid deposition. Beside full work up for dysproteinemia, I would do a Congo red on the tissue.