Ali Mehdi Profile picture
5 Mar, 19 tweets, 16 min read
Mini tweetorial about ICPi related kidney toxicity #irAE2021 #Nephtwitter #IO
AKI is common overall...only a small portion is truly an irAE. #irAE2021 #Nephtwitter #IO
Clinical features: variable and often long latency. Almost a third of patient have bland urinalyses! #irAE2021 #Nephtwitter #IO
By far the most common kidney pathology is acute tubulo-interstitial nephritis! #irAE2021 #Nephtwitter #IO
Other immune pathology have certainly been described and the list keeps expanding! #irAE2021 #Nephtwitter #IO
But not all pathology reported is immune!!! ...Alot of ATN has been described as well!! #irAE2021 #Nephtwitter #IO
PPI use and baseline CKD are risk factors for ICPi related nephritis! PPI use is a potentially modifiable risk factor!! #irAE2021 #Nephtwitter #IO
Let's recap here!! #irAE2021 #Nephtwitter #IO
Our management approach! Early and close evaluation by a nephrologist! #irAE2021 #Nephtwitter #IO
After careful evaluation for alternate pathology, if none is identified, empiric steroid therapy is appropriate. Higher dose and longer taper for more severe cases! #irAE2021 #Nephtwitter #IO
If there are no contraindications for a kidney biopsy, we pursue a biopsy in select cases! #irAE2021 #Nephtwitter #IO
Additional immunosuppression is sometimes needed. Evidence lacking for a specific agent! #irAE2021 #Nephtwitter #IO
So how do these patients do...do they recover? Fortunately yes! Most patients achieve a complete or partial recovery! #irAE2021 #Nephtwitter #IO
This is fortunate as it seems like achieving a good renal response carries a survival advantage! #irAE2021 #Nephtwitter #IO
So your patient with a grade 3/4 kidney toxicity (stage 3 KDIGO AKI) achieves a partial kidney response! Would you re-challenge with iCPI? #irAE2021 #Nephtwitter #IO
Limited data...however based on available data, most re-challenged patients appear to do well without recurrence. #irAE2021 #Nephtwitter #IO
Let's recap here!! #irAE2021 #Nephtwitter #IO
One word about kidney transplant patients on ICPi: early and severe graft rejection in close to 50% with almost 80% graft loss. #irAE2021 #Nephtwitter #IO
Thanks for scrolling down! Hope you found this helpful!!
#irAE2021 #Nephtwitter #IO

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More from @AliMehdiMD

11 Sep 20
1/ Paraproteinemic kidney disease: Cast nephropathy, myeloma kidney, MGUS, MGRS, LCCN, AL, AH, MIDD, LCPT…)

Lost in the alphabet soup!!!

Time for an #MGRS #tweetorial
#NephTwitter #Hemetwitter #MedTwitter #Onconephrology #NSMC
2/ Let’s start with a poll: which of the following disease states can cause MGRS (monoclonal gammopathy of renal significance):
3/ Before we get to the answer, let’s dissect the term MGRS:

Monoclonal Gammopathy:
⚡️Signifies the presence of a "monoclonal" immunoglobulin or its components
⚡️Seen as a spike in the "gamma" region on protein electrophoresis

link.springer.com/referenceworke…
Read 21 tweets

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