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Kenar Jhaveri Profile picture
@kdjhaveri
May 28, 2021 • 26 tweets • 13 min read • Read on X
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Post Grand Rounds SLGT2i and the Kidney Tweetorial
- The Glucoretics - thanks @edgarvlermamd @ChristosArgyrop @jam_hirsch for some slides
Start...PART 1 nature.com/articles/s4158…
SGLT2 is responsible for reabsorbing up to 90% (animal data) of the glucose filtered at the glomerulus. The remaining 10% (animal data) is reabsorbed by SGLT1 that is expressed on the luminal (brush border) surface of cells of the S3 segment of the proximal tubule
Pathophysiology of Diabetic Nephropathy and role of SGLT2
Glomerular hyperfiltration over a long period of time is associated with podocyte stress and loss.
Over a period of time podocyte loss leads to glomerulosclerosis and atrophy
"We should be paying more attention to the proximal tubule" @ChristosArgyrop
A picture says a 1000 words-- the magic word is decreasing hyperfiltration
Now ACEi/ARB + SGLT2i are #BFF slide courtesy @renalmyeloma
What has been approved?
Credence- Amazing renal outcomes/ despite GFR @NEJM @CJASN
DAPA-CKD- look at the ODDS ratios!!
The Kidneys are in for some protections-- time to #flozinate
A must read for all that summarizes all major renal trials onlinelibrary.wiley.com/doi/full/10.10… @ChristosArgyrop
No major issues with biomarkers as well
Next up; Glomerular diseases: Dapa CKD had a good amount of patients with Glomerular diseases. More IgA patients than any large IgA neph trial..
What time is it? -- time to flozinate-- Look at this amazing IgAN response..
Next up- definite cardiorenal benefit as we all saw- so if lasix doesn't work, and thiazides don't do much- add SGLT2i for your cardiorenal patient
Mechanism of Cardiorenal benefit- unclear
Next up- Hypomagnesemia-- more wow!!
Just keep coming along!! ncbi.nlm.nih.gov/pmc/articles/P…
Why? maybe.. Increase glucagon levels– increase mg absorption in the distal tubule; Decrease in insulin levels – leading to movement of Mg to extracellular volume; Hemoconcentration related?; Reduced Mg excretion-effect on ion channel 6; insulin resistant effect on mg wasting
Next up- SIADH--- with empa @JASN_News jasn.asnjournals.org/content/31/3/6…
Next up- SGLT2i also prevent AKI compared to other anti diabetic agents--- hmmm cjasn.asnjournals.org/content/16/1/7…
What else can they do? Improve Anemia in CKD
More EPO production as less effect of #hif
For the #onconephrology world- basic science study canagliflozin significantly attenuates cisplatin-induced nephropathy in C57BL/6 mice and suppresses cisplatin induced renal proximal tubular cell apoptosis in vitro. journals.physiology.org/doi/full/10.11…
Large analysis showing less kidney stones @weddellite @DMalieckal --- hmmm #flozinate for stone prevention..maybe the increase urine flow, decreased uric acid levels increased fluid intake by patients given being on SGLT2i link.springer.com/article/10.100… END PART 1
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More from @kdjhaveri

Kenar Jhaveri Profile picture
Jan 13, 2023
1.Tweet chain alert...on GNs with #covid19 vaccine... what is the most common GN seen post COVID19 vaccine?
2. A study led by Meryl Waldman @NIH creating a registry to evaluate de novo glomerular diseases potentially attributed to COVID19 vaccines published in @ASNKidney360 @ASNKidney may help answer this question journals.lww.com/kidney360/Abst…
3. An earlier study by @Tiff_Caza showed IgA nephropathy, MCD, membranous nephropathy, crescentic GN, and collapsing GN as the most common GNs-attributed to COVID19 vaccines but was limited to 29 patients only pubmed.ncbi.nlm.nih.gov/35372991/ @ASNKidney360
Read 18 tweets
Kenar Jhaveri Profile picture
Jul 23, 2022
Tweetorial: AA amyloidosis and Cancer - New article of analysis in the literature by our #glomerular center visiting faculty @Joyita_4 along with @MSK_Neph faculty @DrOscarLahoud academic.oup.com/ndt/advance-ar… @NDTsocial
2. AA amyloidosis has been classically been associated with -- autoimmune diseases, chronic fevers, infections but AA amyloidosis can develop in a
localized or systemic form in patients with malignant neoplastic disorders
3. We performed a descriptive literature analysis and review of AA amyloidosis with cancer and its treatment.
76 case reports and 3 case/autopsy series with adequate information were included; 2 case reports were excluded due to lack of information on the subtype of amyloidosis.
Read 11 tweets
Kenar Jhaveri Profile picture
Jul 20, 2022
Tweetorial on a new specialized fellowship in @HofstraKidney northwell.edu/news/the-lates… @jmolinet @SIbrahimMD @sfishbane @purvasharma821 @renalmyeloma
1. Applications due for July 2023 start date- interested Nephrology fellows DM me( till website is ready)
2. Glomerular diseases are rare conditions that do require special expertise and expert centers to treat patients. The @NorthwellHealth GN center run by @purvasharma and @kdjhaveri along with expert pathologists @vbijol @Yihe28745445 will help train the next generations fellows
3. #Onconephrology is a field that deals with cancer and the kidney and is very closely linked with glomerular disease and experts in @HofstraKidney will train the fellow in all aspects of this field @renalmyeloma @kdjhaveri @nupuruppal @VBijol @Yihe28745445 @onconephsociety
Read 6 tweets
Kenar Jhaveri Profile picture
Jan 24, 2022
1) #Onconephrology @onconephsociety membership Tweetorial- Join membership--how to become a member! ason-online.org/become-a-member
2)If you are interested in becoming a member of a ASON please go to ason-online.org/become-a-member and fill out the form.
3) We just need an example of scholarly activity in the prior 3 years (any manuscript, abstract, presentation related to oncology/onconephrology). We have tried to keep the requirements to a minimum, in order to encourage trainees to join as well.
Read 8 tweets
Kenar Jhaveri Profile picture
Jan 22, 2022
1) Tweet summary of the review on electrolyte disorders associated with Immunotherapy @CJASN @bdubNephro @nupuruppal @NephroMD cjasn.asnjournals.org/content/early/…
2) Immunotherapy 101 for the Nephrologists- what do Immune checkpoint inhibitors and CAR-T therapy do? @onconephsociety @ASCO
3) Hyponatremia- most common electrolyte abnormality noted with ICI therapy based on several studies, and in real life data pubmed.ncbi.nlm.nih.gov/34556301/ @Kidney_Int @renalmyeloma
Read 15 tweets
Kenar Jhaveri Profile picture
Sep 20, 2021
1)Tweetorial: Immune check point inhibitor related electrolyte disorders short letter @Kidney_Int kidney-international.org/article/S0085-… @renalmyeloma and Vipul Sakhiya - the FDA adverse reporting system.
2) Electrolytes were first mentioned @MayoClinicNeph as most common being hypocalcemia pubmed.ncbi.nlm.nih.gov/29762725/
3)Hyponatremia and other disorders were summarized in a single center study @BWHKidney @BetterCallSeeth @MegSise pubmed.ncbi.nlm.nih.gov/33374011/
Read 10 tweets

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