Table 1.

Concise guidelines for management of glomerular disease patients during the COVID-19 pandemic (opinion-based)

ComponentRecommendations
ImmunosuppressionDiscontinue 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 monitoringReserve 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 careContinue 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 managementChange all appointments to telemedicine video visits
Allow office staff to manage phones and patient messages from home
Develop a standard script of recommendations for patients calling with questions about possible COVID-19 exposure based on CDC guidelines
Use telemedicine video visits rather than telephone calls for patients concerned about COVID-19 infectious symptoms to best triage respiratory status
  • ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; TMP-SMX, trimethoprim-sulfamethoxazole; PCV, pneumococcal conjugate vaccine; PPSV, pneumococcal polysaccharide vaccine; RPGN, rapidly progressive glomerulonephritis; CDC, Centers for Disease Control and Prevention.