Elena Cervantes Profile picture
Mar 5, 2022 8 tweets 5 min read Read on X
1/
Let's be honest...
💥💥“THE TISSUE IS THE ISSUE” 💥💥
#Nephropath #NephMadness

This region features:
🔎PLA2R 🆚Other Membranous Antigens

🔎DNAJB9 🆚IgG4 Disease

READY???👇👇
ajkdblog.org/2022/03/01/nep…
2/
Matchup 1⃣: PLA2R 🆚Other MN Antigens

PLA2R facts
✅Present in healthy human podocytes
✅70-80% 👥with 1ry MN & ~ 60% of ALL MN
✅Serum Ab are measured via ELISA & IF
💡💡DX:
🧪ELISA > 14 RU/mL or
🧪ELISA 2 - 14 RU/mL WITH a positive IFA
pubmed.ncbi.nlm.nih.gov/34556256/
3/
Check this beautiful Visual Abstract by @Vernisartan on the serology based approach to MN

A few more words on Anti-PLA2R titers:
✅>150 RU/mL- ⏫ risk of progression
✅> 45 RU/mL- ⏫risk of recurrence post transplant

💡 Titers are part of the risk stratification algorithm💡
4/
Why do the other MN antigens matter❓

MN antigens:
✅Have different disease associations
✅Are challenging the old nomenclature of 1ry & 2ry MN
✅Opened the door for research on antigen specific therapies
5/
Matchup 2⃣: DNAJB9🆚IgG4

DNAJB9 facts:
✅~💯 sensitivity & specificity for FIBRILLARY GN
✅🔬EM: ~20 nm randomly organized fibrils
✅44% of 👥progress to ESKD within 4 years
✅Tx: ❓ 1/3 of patients respond to rituximab

Check this wonderful VA by @iheartkidneys
6/
IgG4 facts:
✅Tubulointerstitial nephritis is the most common kidney manifestation
✅🔬PAS & Silver stain: "storiform fibrosis" is characteristic
✅Excellent response to steroids -- & 20% relapse

Check this amazing VA by @edgarvlermamd
7/

So who do YOU think will be the winner of this region❓❓ #BlueRibbonPanel
Thank you @nephrosharma @Maximal_Change @Khairallah_P @Nephro_Sparks @arkanalabs for inviting me to be part of this fun region and for your feedback! #NephMadness

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More from @Elena_Cervants

Oct 31, 2021
1/
🚨Is sodium bicarbonate useful to prevent Rhabdomyolysis induced AKI ❓❓🚨

We get asked this all the time! But in order to understand it, let's start with a simple question

What is the mechanism of AKI in rhabdomyolysis ❓❓
2/
1⃣What happens in rhabdo?
⚡️Muscle necrosis → release of intracellular components (enzymes-CK, electrolytes & myoglobin)
⚡️Fluid sequestration within damaged muscle → volume depletion →🚨 RAAS➕SNS
⚡️Oxidative injury →⬆️ in vascular mediators → ⬇️renal blood flow
3/
We might see ⬆️Creatine Kinase (CK) levels somewhat frequently...

BUT...

Is there a CK level that predicts AKI❓
⚡️There is no defined threshold value of CK
⚡️CK levels < 15,000 to 20,000 U/ L on admission usually have a low risk of AKI

pubmed.ncbi.nlm.nih.gov/16490621/
Read 19 tweets

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