Be sure to join us TOMORROW here on @ckd_ce for our first ORIGINAL accredited content . . . from none other than @edgarvlermamd . . . whom you #kidney-oriented clinicians will know as a comforting and familiar presence and as an AWESOME teacher. He'll be talking about ...
2) This #tweetorial is accredited for 0.5h CE/#CME#MedEd#FOAMed and is supported by an educational grant from Travere Pharmaceuticals. This program is intended for healthcare providers. Faculty disclosures are listed at ckd-ce.com/disclosures/.
3) IgA nephropathy (#IgAN) is the most common pattern of primary glomerular disease worldwide & remains a leading cause of CKD & kidney failure. Genome-Wide Association Studies (GWAS) indicate a differing worldwide risk for IgAN.
4) In populations of White descent, #IgAN is more common in M than F by a ratio of 3:1; ratio approaches 1:1 in most Asian populations
5) Although patients may present at any age, the peak incidence is in the 2nd and 3rd decade of life. The wide range of clinical presentations of IgAN varies in frequency with age. No clinical pattern is pathognomonic of IgAN renalfellow.org/2009/02/10/man… archive.kidneynews.org/kidney-news/pr…
6) First described over 5 decades ago by Jean Berger, it continues to be not only a diagnostic, but treatment dilemma pubmed.ncbi.nlm.nih.gov/21705126/
7) Central to the pathophysiology of #IgAN is the systemically ⬇️ glycosylation of O-linked glycans in the hinge region of the IgA1 molecule, leading to dysregulation & elevated serum levels of galactose-deficient IgA1 (Gd-IgA1) pubmed.ncbi.nlm.nih.gov/30665568/ pubmed.ncbi.nlm.nih.gov/22318424/
8) These aberrant IgA1 molecules are then deposited w/in the kidney mesangium leading to immune complex formation, promotion of cell growth, & production of proinflammatory cytokines, chemokines, & growth factors.
9) Complement activation also plays a role in inflammation
11) The pathognomonic finding is the presence of globular deposits of IgA accompanied by weaker staining for C3, IgG, and IgM in the mesangium on immunofluorescence microscopy.
12) On light microsocopy, findings can be variable and include mesangial cell proliferation, mesangial expansion, focal or diffuse proliferative GN, crescentic GN, chronic sclerosing GN, MPGN 1 pattern, and endo- and extra- capillary hypercellularity pubmed.ncbi.nlm.nih.gov/26498419/
13) EM confirms the presence of electron-dense deposits in the mesangium but may also occur in subendothelial and subepithelial spaces
17) Let's see how this works. 48 year old, black ♂️, with an eGFR of 50ml/min/1.73m2 at the time of biopsy.
BP 140/90, 24-hour Urine Protein 2000 mgs/day
Medications: Lisinopril 40 daily, Chlorthalidone 25 daily
Kidney Biopsy: IgA nephropathy (M1, E1, S0, T1).
18) You want to know the risk of progression of kidney disease at 6 months from the time of the kidney biopsy. pubmed.ncbi.nlm.nih.gov/28529339/
So plug the data from tweet 17 into the formula in tweet 16 and check back tomorrow for your answer!
19) Welcome back! You are learning about #IgAN and earning CE/#CME on your ONLY source of accredited #tweetorials in #CKD. I am @edgarlerma and I thank you for joining us. Please FOLLOW this new feed!
20) How’d you do? You should have come up with “The risk of a 50% decline in estimated GFR or progression to end-stage renal disease 0.5 years after renal biopsy is 0.52%.”
21) Two full prediction models were shown to be accurate and validated methods for predicting disease progression and patient risk stratification in IgAN in multi-ethnic cohorts #VisualAbstract by @divyaa24
22) The International IgAN Prediction Tool is a valuable resource to quantify risk of progression & inform shared decision-making w/ patients.
It incorp's clinical info at the time of biopsy & cannot be used to determine the likely impact of any particular treatment regimen
23) There is insufficient evidence to support the use of the Oxford Classification MEST-C score in determining whether immunosuppression should be commenced in IgAN.
24) There is insufficient evidence to support the use of the Oxford Classification MEST-C score in determining when any glucocorticoid therapy should be commenced
25) Which biomarkers have been validated for IgAN?
A. Serum Gd-IgA1 levels
B. Serum anti-glycan antibody
C. Serum levels of IgA-1 containing circulating immune complexes
D. Others
27) High risk of progression in IgAN is currently defined as proteinuria >0.75–1 g/d despite ≥90 days of optimized supportive care
28) In the @goKDIGO 2021 guidelines, mgt of IgAN focuses on non-immunosuppressive strategies (supportive care) to slow progression of the disease:
- Rigorous BP control
- Optimal inhibition of RAAS
- Lifestyle mods (weight⬇️, exercise, smoking cessation, & dietary Na restriction)
1) Welcome to a new #accredited #tweetorial from the partnership of @ckd_ce and @ISNeducation. This tweetorial has been prepared by @Dilushiwijay and provides 0.75hr CE/#CME.
2) Statement of accreditation and author disclosures can be found at . No industry funding was provided for this program, which is accredited by @academiccme.
So . . .
How much do you know about #IgAN? 🤔ckd-ce.com/disclosures/
3) Which of these statements about #IgAN is FALSE?
A. It is the most common primary glomerulonephritis
B. It is benign
C. It has a heterogenous presentation
D. It is characterized by dominant or co-dominant IgA staining on biopsy
1) Welcome to this #accredited#tweetorial on genetic testing in the evaluation of patients with cystic kidney disease. #Kidney#cysts are a frequent finding, ranging from simple cysts to suspected or confirmed #ADPKD.
Expert author @dguerrot of @CHURouen 🇫🇷 leads us!
2) This #accredited#tweetorial series on #kidneydisease#CKD is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance. It is not intended for US- or UK-based HCPs. Accreditation statement & faculty disclosures at ckd-ce.com/disclosures/.
1) Welcome to this new #accredited#tweetorial on “Strategies to Apply Current Clinical Trial Data for SGLT2i to Reduce the Progression of CKD,” authored by our ⭐️tweetorialist Edgar V. Lerma 🇵🇭 @edgarvlermamd
2) She is a member of UKCPA Diabetes & Endocrinology committee @UKCPADiabetes & works across #diabetes, #endocrinology, & emergency/acute care in Secondary Care. She is currently involved in development of regional guidelines & education to support medicines optimisation for PLWD
3a) This program is intended for healthcare professionals and is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company.
2) This #accredited#tweetorial series on the foundations of #kidneydisease#DKD through the lens of #T2D is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers.