[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-420547-105":59,"doc-detail-420547-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","1-minute-pearlspitfalls-for-the-clinician","1-Minute Pearls/Pitfalls for the Clinician","","Article examines management strategies for two common high-risk clinical scenarios: venous thromboembolism in high-risk membranous nephropathy and hepatitis B core antibody–positive patients preparing to receive immunosuppressive therapy. It presents case-based reasoning for antithrombotic and nephropathy-directed steps, emphasizing the role of disease severity features and timely nephrology involvement. For hepatitis B, it outlines phase-based interpretation of serologies and the reactivation risk created by immunosuppression, including in resolved infection.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/1-minute-pearlspitfalls-for-the-clinician/420547/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/1-minute-pearlspitfalls-for-the-clinician/420547.png","ImageObject",300,407,{"name":92,"@type":93},"dawugda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How should patients with venous thromboembolism and high-risk membranous nephropathy be managed?","Question",{"text":112,"@type":113},"Start with standard DVT management and address the nephrotic, hypercoagulable state. Use conservative primary membranous nephropathy care but promptly add immunosuppression when high-risk features are present, including DVT and markedly elevated PLA2R levels, with close monitoring of renal function, albumin, proteinuria, and repeat PLA2R.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What hepatitis B evaluation is needed before initiating immunosuppressive therapy in a patient with positive hepatitis B core antibody?",{"text":117,"@type":113},"Interpret the patient’s hepatitis B phase using HBe antigen/antibody, hepatitis B surface antigen/antibody, hepatitis B core antibody, ALT, and HBV DNA. This determines whether antiviral management and prophylaxis are indicated prior to immunosuppression.",{"name":119,"@type":110,"acceptedAnswer":120},"Does hepatitis B surface antibody alone rule out hepatitis B reactivation risk?",{"text":121,"@type":113},"No. Reactivation risk can occur in resolved infection with core-antibody positivity even when surface antigen is negative, and the presence of surface antibody does not exclude the need for antiviral prophylaxis when immunosuppression is planned.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},420547,1790719467,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3985747870947,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","1-Minute Pearls/Pitfalls for the Clinician  \n1-Minute Pearls/Pitfalls for the Clinician  \nKwame Dapaah-Afriyie, MD, MBA, FACP, FRCP(London), SFHM1,2  \n1 Division of Hospital Medicine, Department of Medicine, Miriam Hospital, 2 Department of Medicine, Brown University  \nJournal of Brown Hospital Medicine Vol. 5, Issue 1, 2025  \nArticle Information  \nKeywords: membranous nephropathy, VTE, hepatitis B, hepatitis B core antibody, immunosuppression  \n[https://doi.org/10.56305/001c.153886](https://doi.org/10.56305/001c.153886)  \nSubmitted: November 25, 2025 EST  \nAbstract  \nThis article examines the management of VTE in patients with high-risk membranous nephropathy and the care of hepatitis B core antibody–positive patients preparing to start immunosuppressive therapy.  \nAccepted: December 05, 2025 EST  \nPublished: January 01, 2026 EST  \nquestion 1: how should patients with venous thromboembolism and highrisk membranous nephropathy be managed?  \nA 53-year-old man with a remote history of hepatitis B infection and a recent diagnosis of membranous nephropathy was admitted with worsening anasarca and found to have a right lower-extremity deep-vein thrombosis (DVT). He has no family history of chronic kidney disease or hypercoagulable disorders and is taking losartan and bumetanide. On examination, he was afebrile, with a heart rate of 89/ min and blood pressure of 124/54 mmHg and appeared non-pale and anicteric. He had periorbital edema without conjunctival injection, decreased air entry at the lung bases without wheezes or crackles, and a distended but soft, nontender abdomen with a positive fluid wave and normal bowel sounds. Neurologically, he was alert with no focal deficits. His extremities demonstrated extensive bilateral edema, with tenderness and erythema over the right thigh and diminished right-sided pedal pulses, but no induration. Laboratory studies showed a normal CBC and renal function but significant hypoalbuminemia at 2.1 g/dL. Atthe time of his initial nephropathy diagnosis, his 24-hour urine protein was 7.5 g/day, his PLA2R antibody titer was  \n125 RU/mL, and hepatitis B serologies showed positive surface and core antibodies with negative antigens. He was transitioned from heparin to apixaban. What is the nextstep in his management?  \nA: This patient’s DVT occurred in the context of nephrotic-range proteinuria, which contributes to a hypercoagulable state through urinary losses of antithrombin III, protein S, and fibrinolytic factors such as plas-  \nminogen. Additionally, severe hypoalbuminemia stimulates hepatic production of various proteins, leading to elevated levels of procoagulants including fibrinogen, factor V, and factor VIII. Initial management of primary membranous nephropathy is generally conservative and involves loop diuretics for edema, renin–angiotensin system blockade to reduce proteinuria, and statin therapy for dyslipidemia, with approximately 30% of patients achieving spontaneous remission within two years.  \nIn the presence of high-risk features for disease progression, the addition of immunosuppressive regimen is recommended. Delays in initiation of immunosuppressive therapy results in a much higher rate of progression to end stage renal disease (ESRD) . High risk features inpatients with membranous nephropathy include:  \n• Acute kidney failure  \n• DVT or renal vein thrombosis  \n• Proteinuria >8000mg/day  \n• PLA2R antibody levels> 100RU/ml  \nIn light of his elevated PLA2R level and new DVT, timely nephrology consultation to assess for initiation of immunosuppression is warranted. Close monitoring of his renal function, serum albumin, proteinuria, and repeat PLA2R titers will be essential. Because up to half of patients with persistent nephrotic-range proteinuria ultimately progress to ESRD, timely escalation of therapy is critical. Available immunosuppressive options include steroid–cyclophosphamide regimens, rituximab, and calcineurin inhibitors.1  \nquestion 2: how should patients with a positi","cbCaiqnKZb7ug9q7","https://ap.wps.com/l/cbCaiqnKZb7ug9q7","pdf",279950,"English","# Abstract\n## VTE in high-risk membranous nephropathy\n## Management of hepatitis B core antibody–positive patients before immunosuppression","[{\"question\":\"How should patients with venous thromboembolism and high-risk membranous nephropathy be managed?\",\"answer\":\"Start with standard DVT management and address the nephrotic, hypercoagulable state. Use conservative primary membranous nephropathy care but promptly add immunosuppression when high-risk features are present, including DVT and markedly elevated PLA2R levels, with close monitoring of renal function, albumin, proteinuria, and repeat PLA2R.\"},{\"question\":\"What hepatitis B evaluation is needed before initiating immunosuppressive therapy in a patient with positive hepatitis B core antibody?\",\"answer\":\"Interpret the patient’s hepatitis B phase using HBe antigen/antibody, hepatitis B surface antigen/antibody, hepatitis B core antibody, ALT, and HBV DNA. This determines whether antiviral management and prophylaxis are indicated prior to immunosuppression.\"},{\"question\":\"Does hepatitis B surface antibody alone rule out hepatitis B reactivation risk?\",\"answer\":\"No. Reactivation risk can occur in resolved infection with core-antibody positivity even when surface antigen is negative, and the presence of surface antibody does not exclude the need for antiviral prophylaxis when immunosuppression is planned.\"}]","1-Minute Pearls/Pitfalls for the Clinician | PDF",1790621432,13]