@nast_cynthia provided a great overview of the pathology, clinical features, associations, + prevention of CKD of unknown etiology @GlomCon. Here are some pearls:

1. CKDu is a tubulointerstitial kidney disease disproportionately affecting young men in agricultural communities. 2. CKDu is prevalent, particularly in areas of the world with a high heat index.

Dr. Ian Roberts gave a thought-provoking talk today at the @renalpathsoc satellite meeting on glomerulonephritis with monotypic IgA deposits.

Here's some questions he had us consider and follow the thread below to learn more: Light chain restriction in IgA nephropathy is not rare, but nearly always involves lambda light chain. The frequency is between 2 and 38.5% - quite a wide range between studies.

Dr. Virginie Royal gave a beautiful overview of diseases of monoclonal immunoglobulin deposition involving the tubulointerstitum.
Here are some pearls: Clinical presentations can be variable, but often include proteinuria +/- AKI, as well as evidence of tubular dysfunction (including Fanconi syndrome).

Dr. Nicole Andeen presented some pearls on fibrillary GN with light chain restricted deposits at the @Renalpathsoc satellite meeting.

The majority of cases of LC restricted fibrillary cases do not have identifiable paraproteins. Only 1% of monotypic fibrillary GN cases have an identifiable matching monoclonal paraprotein.

An overview of PGMID from Dr. Samih Nasr: (@Renalpathsoc meeting)

PGMID is one of the most common types of monoclonal gammopathies of renal significance. The classification of MGRS lesions (by the international kidney monoclonal gammopathies research group) is below. PGMID is the second most common type of MGRS lesion on kidney biopsy but is a rare disease overall.

There was a great review on SGLT2 inhibitor mechanisms, indications, and trials by @GlassockJ at @GlomCon this morning.

Here is a timeline for key treatment trials in diabetic nephropathy, with recent advances coming from SGLT2 inhibitor efficacy. /1 SGLT2 proteins were studied for the last 30 years, although modern SGLT2 inhibitors were under development only in this last decade. /1

The @renalpathsoc put on a terrific virtual satellite meeting. Here are some pearls from the lovely talks. Thanks to @CandiceRoufosse @ParmjeetRandha5 @ldcornell @mmengelUofA @abfarris3 for teaching us today!

Here are some pearls! /1 In 1991, the Banff working group was formed. Ever since then, a group of experts (likely many members of the @renalpathsoc) meet every 2 years to discuss and refine the classification for allograft rejection.

Let's start with some definitions from @CandiceRoufosse /2

Here are some pearls from a very informative talk by Dr. Deborah Adey today on immunosuppressive agents in kidney transplant recipients. @GlomCon /1 The focus of immunosuppression in this talk was primarily in targeting T cells. There are 3 signals required for T cell activation - TCR engagement with MHC, co-stimulatory signals, and action of cytokines. /2

Dr. Cynthia Nast gave us some great examples of ultrastructural findings in common kidney diseases, as well as several zebras today @GlomCon
Let's have some fun with EM! /1 Podocyte ultrastructural changes - there are changes occurring in podocytopathies other than just foot process effacement, such as actin cytoskeleton condensation, microvillous transformation, blunting, widening, and 'halo' formation. /2

Great talk today on biomarkers and novel treatments of antibody mediated rejection by @adjamali at @GlomCon

Here are some pearls:
1. ABMR is a major cause of allograft failure. /1 2. Patient survival is poor following graft failure (by any cause) with a >3-fold increase in mortality.
Early detection and treatment of rejection is critical to preserve allograft function. /2

Great talk this morning @GlomCon highlighting the role of molecular diagnostics to get further information from kidney allograft biopsies! Transcriptomic studies may become a key ancillary diagnostic tool in transplant pathology. /1 This technology is pretty new - here's a timeline of discoveries in gene expression testing in allografts. /2

Learned a lot from @ldcornell today at @GlomCon about antibody-mediated rejection. /1
Let's start with the 3 main features of ABMR:
(1) microvascular inflammation
(2) C4d
(3) DSA or non-DSA Abs For chronic antibody mediated rejection, you can see these patterns (not all need to be present). /2
(1) Transplant glomerulopathy
(2) PTC multilayering
(3) Transplant arteriopathy

Wonderful topic by @MPAlexanderMD, @timuncin_taner, @MdLagu on COVID pathology, pathophysiology, and management @GlomCon today! A 🧵 There are nearly a half a million deaths from COVID-19 currently and 228 billion infections./2

Pearls from @GlassockJ 's terrific talk on recurrent glomerulonephritis in kidney allografts at #GlomCon:
1) Recurrence of primary FSGS is as high as 70% in allografts (when genetic and secondary causes rigorously excluded) / 1 2) Recurrent FSGS in a second allograft when the first allograft was lost from recurrent FSGS is close to 100%, can be identified early by marked proteinuria /2

Neural epidermal growth factor-like 1(NELL1) is a recently identified antigen in membranous nephropathy. Here’s the take home - NELL1 is a rare form of membranous, but is NOT rare in malignancy. Want more? Read on! 1 /21 We used protein G immunoprecipitation to elute immune complexes directly from frozen kidney biopsy tissue and interrogated them by mass spectrometry. 2/21

I really enjoyed the membranous nephropathy session (happy 10th birthday PLA2R) at #KidneyWk, and here were some highlights: @LaurenceHBeckJ1 PLA2R titers fall 3-6 months before reduction in proteinuria in MN. PLA2R titers are used as a secondary endpoint for both the GEMRITUX trial and MENTOR trials #KidneyWk.