1/
📢Hello #MedTwitter.
This month’s @ASPNeph Renal Pathology webinar is all about #IgAVasculitis #IgAVN formerly known as #HSP.
Urine for a treat!
#nephtwitter
Let’s do a quick poll! Iga Vasculitis is most common in which age group?
📢Hello #MedTwitter.
This month’s @ASPNeph Renal Pathology webinar is all about #IgAVasculitis #IgAVN formerly known as #HSP.
Urine for a treat!
#nephtwitter
Let’s do a quick poll! Iga Vasculitis is most common in which age group?
2/
A: <10 years, about 90% of cases of IgA Vasculitis are seen in children under 10
🤯
A: <10 years, about 90% of cases of IgA Vasculitis are seen in children under 10
🤯
3/
Let's talk numbers-
1⃣Kidney involvement in 30-50%
2⃣Kidney involvement appears within 6 weeks in 91%
3⃣IgA Vasculitis preceded by URI in 50%
4⃣If nephro findings, 10% progress to ESRD/severe CKD in 10 years
PMID: 139081 PMID: 32356414 PMID: 32060820
Let's talk numbers-
1⃣Kidney involvement in 30-50%
2⃣Kidney involvement appears within 6 weeks in 91%
3⃣IgA Vasculitis preceded by URI in 50%
4⃣If nephro findings, 10% progress to ESRD/severe CKD in 10 years
PMID: 139081 PMID: 32356414 PMID: 32060820
4/
What's with the two names? PMID: 32356414
HSP 👉 Johann Schönlein 👨🔬 and Eduard Henoch 🧑🎓 made the first detailed analysis of this disease.
IgA Vasculitis 👉 Based on IgA deposited in blood vessel walls.
Check this article out on the two terms: libgallay.com/2021/01/13/iga…
What's with the two names? PMID: 32356414
HSP 👉 Johann Schönlein 👨🔬 and Eduard Henoch 🧑🎓 made the first detailed analysis of this disease.
IgA Vasculitis 👉 Based on IgA deposited in blood vessel walls.
Check this article out on the two terms: libgallay.com/2021/01/13/iga…
5/
Tetrad of findings:
⚡️Palpable purpura
⚡️Joint pain and/or swelling
⚡️GI issues- pain, intussusception, hematochezia
⚡️Renal Involvement- hematuria, proteinuria, elevated creatinine
Uptodate
Tetrad of findings:
⚡️Palpable purpura
⚡️Joint pain and/or swelling
⚡️GI issues- pain, intussusception, hematochezia
⚡️Renal Involvement- hematuria, proteinuria, elevated creatinine
Uptodate
6/
How about another question?!
Can we prevent kidney disease associated with IgA vasculitis?? 😷🥼🏥
How about another question?!
Can we prevent kidney disease associated with IgA vasculitis?? 😷🥼🏥
7/
A: Sadly, No…
😞
Evidence suggests that steroids early in IgA vasculitis don’t prevent kidney involvement.
PMID: 26258874
A: Sadly, No…
😞
Evidence suggests that steroids early in IgA vasculitis don’t prevent kidney involvement.
PMID: 26258874
8/
We still aren't sure why IgA vasculitis happens but we have some ideas...💡
PMID: 23684700
Bacteria, viruses, and protozoa suggested as possible triggers:
We still aren't sure why IgA vasculitis happens but we have some ideas...💡
PMID: 23684700
Bacteria, viruses, and protozoa suggested as possible triggers:
9/
🧬 Some genes may predispose children:
PMID: 23684700
🧬 Some genes may predispose children:
PMID: 23684700
10/
What causes IgA Vasculitis??
Hastings et al. recently published an update on the pathogenesis of IgA vasculitis with nephritis. Check out their 4 hit hypothesis:
PMID: 33818625
What causes IgA Vasculitis??
Hastings et al. recently published an update on the pathogenesis of IgA vasculitis with nephritis. Check out their 4 hit hypothesis:
PMID: 33818625
11/
Diagnosis- usually clinical manifestations
🤷♀️ Not obvious? 🤷 Not sure? 🤷♂️ Don't know?
A skin biopsy can help! 🦸
PMID 9366584
Leukocytoclastic vasculitis in postcapillary venules with IgA deposition in small blood vessels of superficial dermis.
Diagnosis- usually clinical manifestations
🤷♀️ Not obvious? 🤷 Not sure? 🤷♂️ Don't know?
A skin biopsy can help! 🦸
PMID 9366584
Leukocytoclastic vasculitis in postcapillary venules with IgA deposition in small blood vessels of superficial dermis.
12/
What about a kidney biopsy? 🔬
Who gets one??
✅Nephrotic-range proteinuria
✅Elevated creatinine
What about a kidney biopsy? 🔬
Who gets one??
✅Nephrotic-range proteinuria
✅Elevated creatinine
13/
Kidney biopsy findings:
Uptodate
LM: mesangial proliferation ↔️ severe crescentic glomerulonephritis
IF: IgA deposition in the mesangium
EM: electron-dense deposits in mesangial areas, occ extends into peripheral capillary loops
Kidney biopsy findings:
Uptodate
LM: mesangial proliferation ↔️ severe crescentic glomerulonephritis
IF: IgA deposition in the mesangium
EM: electron-dense deposits in mesangial areas, occ extends into peripheral capillary loops
14/
The ISKDC classification has long been used to evaluate severity of kidney involvement on biopsy: PMID: 28197887
🕵️📜
The ISKDC classification has long been used to evaluate severity of kidney involvement on biopsy: PMID: 28197887
🕵️📜
15/
The Oxford MEST-C classification used for IgAN is also being used more and more in IgA vasculitis:
🕵️📜
The Oxford MEST-C classification used for IgAN is also being used more and more in IgA vasculitis:
🕵️📜
16/
What is reported on your biopsy reports?
What is reported on your biopsy reports?
17/
Monitoring for kidney involvement in IgA vasculitis is very important. Children should have a urine dipstick performed weekly for 6 months (97% of children with IgA Vasculitis who develop renal involvement do so within 6 months, 1st morning void preferred).
Uptodate
Monitoring for kidney involvement in IgA vasculitis is very important. Children should have a urine dipstick performed weekly for 6 months (97% of children with IgA Vasculitis who develop renal involvement do so within 6 months, 1st morning void preferred).
Uptodate
18/
To finish things off:
How do we treat?💊💉🏥
To finish things off:
How do we treat?💊💉🏥
19/
Info on IgA vasculitis treatment is limited but here are some studies you can look into!
Info on IgA vasculitis treatment is limited but here are some studies you can look into!
20/
@Landmark_neph, @nephron_andon, and @dimirenal_md also created a great timeline looking into IgA vasculitis and steroids.
@Landmark_neph, @nephron_andon, and @dimirenal_md also created a great timeline looking into IgA vasculitis and steroids.
21/
Refer to KDIGO 2012, European guidelines, and newer studies to get even more information on treatment.
Reply to this tweet and let us know your thoughts!
Refer to KDIGO 2012, European guidelines, and newer studies to get even more information on treatment.
Reply to this tweet and let us know your thoughts!
22/
Interested in learning more?? 🔎🔎
For a case-based discussion with pathologist and expert login to @ASPNeph website, July webinar. Answer questions to get #MOC2credits #Membereducation #ASPNFOAMgroup
@drM_sudha @menonshina @yardleyjojo @Trumidor
and Smitha Vidi
Interested in learning more?? 🔎🔎
For a case-based discussion with pathologist and expert login to @ASPNeph website, July webinar. Answer questions to get #MOC2credits #Membereducation #ASPNFOAMgroup
@drM_sudha @menonshina @yardleyjojo @Trumidor
and Smitha Vidi
23/
Special thanks to @drM_sudha @priti899 @SwastiThinks
and @RoshanPGeorgeMD for all your help making my first tweetorial!
Special thanks to @drM_sudha @priti899 @SwastiThinks
and @RoshanPGeorgeMD for all your help making my first tweetorial!
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