Edgar V. Lerma πŸ‡΅πŸ‡­ Profile picture
Jun 7, 2021 β€’ 11 tweets β€’ 9 min read β€’ Read on X
Tweetorial: @goKDIGO Level 2B Recommendation - We suggest that adults w/ high BP & CKD be treated with a target SBP <120, when tolerated, using standardized office BP measurement (1/9) #Nephpearls
πŸ‘‰ kdigo.org/guidelines/blo…
There is evidence that targeting SBP <120 when measured under standardized conditions, reduces CV events & all-cause mortality in CKD

πŸ“Œ In most people w/ high BP (incl. frail & elderly), these benefits appear to outweigh the risks of harm (hypotension & AKI) (2/9) #Nephpearls
There is however, some uncertainty that the benefits outweigh the harms in certain scenarios (3/9) #Nephpearls
πŸ‘‰ kdigo.org/guidelines/blo…
If the patient cannot tolerate SBP <120 despite a slow, gradual decrease in SBP over months, efforts should be made to maintain SBP <130, <140, or an even higher tolerated SBP goal (4/9) #Nephpearls
Individualization based on trial and error prevails, as in many aspects of medical practice (5/9) #Nephpearls
The importance of standardized BP measurement when applying this guideline cannot be overemphasized (6/9) #Nephpearls

πŸ“Œ Routine, non-standardized office BP measurements often, but not invariably, overestimate BP compared to measurements under standardized conditions
No correction factor can be used to convert routine BP to standardized BP measurement by calculation (7/9) #Nephpearls
Why no target DBP? (8/9) #Nephpearls

Wide pulse pressure (common in CKD) implies that achieving SBP <120 will almost certainly result in DBP <70 in the majority making a separate DBP target redundant

Literature on RCTs targeting DBP w/ clinical outcomes is scarce (esp. in CKD)
One should not rely on routine office BP to adjust BP-lowering therapy (9/9) #Nephpearls

πŸ“Œ It should be noted that @HTNCanada recommends an SBP target <120 using standardized BP measurement consistent w/ @goKDIGO guideline

Table created by @hswapnil

onlinecjc.ca/article/S0828-…
How did @goKDIGO BP Guidelines compare with the ACC/ AHA Hypertension Guidelines? #Nephpearls
πŸ‘‰ kdigo.org/guidelines/blo…
In ADPKD, as compared w/ standard BP control, rigorous BP control was asso. w/ slower increase in total kidney volume (TKV), no overall change in eGFR, a greater decline in LV mass index, and greater reduction in urinary albumin excretion #Nephpearls

nejm.org/doi/full/10.10…

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More from @edgarvlermamd

Feb 26, 2022
Advancing Evidence-Based Care in Diabetes and CKD
#ISNWCN πŸ‡²πŸ‡Ύ #Nephpearls

πŸ‘‰ kdigo.org/wp-content/upl…
Holistic approach for improving outcomes in patients with Diabetes and CKD
#ISNWCN πŸ‡²πŸ‡Ύ #Nephpearls
Glucose-lowering agents in Type 2 Diabetes (T2D) and CKD: Indications and dose adjustments
#ISNWCN πŸ‡²πŸ‡Ύ #Nephpearls
Read 9 tweets
Feb 26, 2022
.@goKDIGO Glomerular Diseases Guideline: Reflections on a Decade of Progress with @adrianliew8 @ReichHeather @Dr_KeishaGibson
#ISNWCN πŸ‡²πŸ‡Ύ #Nephpearls

πŸ‘‰ kdigo.org/wp-content/upl…
IgA Nephropathy: A 1st step is in treating IgA Nephropathy is assessing "prognosis" based on data available at the time of biopsy

@goKDIGO suggest using the "prediction tool" that was derived from the largest & most geographically diverse cohort to date

#ISNWCN πŸ‡²πŸ‡Ύ #Nephpearls
IgA Nephropathy: The @goKDIGO treatment algorithm recommends consideration of use of corticosteroids in patients with "persistent proteinuria >1g/day" if the risk/benefit profile is favorable

πŸ“Œ A GFR of 30 is considered a threshold for treatment

#ISNWCN πŸ‡²πŸ‡Ύ #Nephpearls
Read 13 tweets
Feb 23, 2022
First clinical-grade porcine πŸ– kidney xenotransplant using a human decedent model ca. 2022 from @amjtransplant #NephJC #Nephpearls

#VisualAbstract by @NamrataYParikh

πŸ‘‰πŸΌ pubmed.ncbi.nlm.nih.gov/35049121/ Image
Attitudes to Clinical Pig Kidney Xenotransplantation among Medical Providers and Patients ca. 2020 from @ASNKidney360 #Nephpearls

kidney360.asnjournals.org/content/1/7/657 ImageImage
Paving the Path toward Porcine Organs for Transplantation ca. 2017 from @NEJM #NephJC #Nephpearls

nejm.org/doi/full/10.10… ImageImage
Read 4 tweets
Jan 30, 2022
Nephrolithiasis 101: When to order a 24-hour urine collection #Nephpearls

Multiple or metabolically active stones (stones that increase in size/ number w/in a year)

Children

Demographic groups not typically prone to stone formation

Stones other than those containing calcium ImageImage
Interpretation of urine chemistries to identify lithogenic risk factors and assess the contribution of diet to the formation of kidney stones ca. 2016 from @ravineja #Nephpearls

sciencedirect.com/science/articl… Image
Neglected analytes in the 24 hour urine: ammonium and sulfate ca. 2021 from @CO_Neph_Hype @ravineja #Nephpearls

πŸ‘‰ pubmed.ncbi.nlm.nih.gov/34798636/ ImageImageImageImage
Read 4 tweets
Jan 26, 2022
PREDNOS 2: Evaluation of Daily Low-Dose Prednisolone During URTI to Prevent Relapse in Children w/ Relapsing Steroid-Sensitive Nephrotic Syndrome ca, 2022 from @JAMAPediatrics #NephJC #IPNAJC #Nephpearls

#VisualAbstract by @drM_sudha

jamanetwork.com/journals/jamap…
Low-dose versus conventional-dose prednisolone for nephrotic syndrome relapses: a randomized controlled non-inferiority trial ca. 2022 from @Ped_Neph #NephJC #IPNAJC #Nephpearls

#VisualAbstract by @md_abdulqader83

link.springer.com/article/10.100…
PREDNOS: Sixteen-week versus standard eight-week prednisolone therapy for childhood nephrotic syndrome ca. 2019 from @bmj_latest #NephJC #IPNAJC #Nephpearls

#VisualAbstract by @jbda19

pubmed.ncbi.nlm.nih.gov/31156083/
Read 5 tweets
Nov 17, 2021
Clinical Practice Guideline for the Management of Glomerular Diseases ca. 2021 from @goKDIGO #NephJC #Nephpearls
#VisualGraphics by @michaelturk6

Executive Summary pubmed.ncbi.nlm.nih.gov/34556300/
Full Guideline pubmed.ncbi.nlm.nih.gov/34556256/
The spectrum of glomerular diseases from @neilturn #NephJC #Nephpearls

πŸ‘‰ global.oup.com/academic/produ…
Nephrotic range proteinuria does "not always" mean nephrotic syndrome #NephJC #Nephpearls

πŸ‘‰ pubmed.ncbi.nlm.nih.gov/34556256/
Read 4 tweets

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