1/ Nephrologists & cardiologists might agree on 1 #NephMadness region: #CardioRenal

Matchup 1:
Diuretic resistance mechanisms vs treatment

ajkdblog.org/2022/03/01/nep…

So many diuresis roadblocks, summarized below by @hellokidneyMD

@DrFlashHeart @NishaKidneyDoc @HeartDocSadiya 2/

Loop diuretics have an S-shaped dose-response curve

ajkdblog.org/2022/03/01/nep…

#NephMadness #CardioRenal @kidney_boy

1/

Another #immunosuppression #tweetorial...spotlight today on #belatacept today

How do you say it? @Babybel @MedTweetorials 2/

Belatacept is the FUSION protein that has been the @NKOTB in #kidneytransplant - having been approved for use in 2011.

What's fused?

1. Human IgG1 Fc fragment
2. Extracellular domain of cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4)

pubmed.ncbi.nlm.nih.gov/25416857/

1/

As kidney replacement therapies (KRT) have become a strained and limited resource during the #COVID19 pandemic, here is a quick #tweetorial on how these treatments work:

What is the main mechanism by which clearance is achieved during intermittent #hemodialysis? 2/

KRT has 2 powers:
1⃣Clearance (removal of solutes, like potassium 🍌)
2⃣Volume removal 💧

...and it comes in 2 flavors:
1⃣Intermittent
2⃣Continuous

1/ In light of the conversion of many of our interactions to virtual experiences, a #tweetorial on @zoom_us features that may enhance your teaching/conferences/meetings etc (No COI to disclose)

Which of the following features does Zoom have?

#MedEd #COVID19 #COVIDー19 2/ Answer: All of the Above

Step 1: Log into your @zoom_us profile and personalize it to activate the features you want

zoom.us/profile/setting

1/ A continuation #tweetorial from my last one introducing human leukocyte antigen (#HLA) , the cell surface antigen...

Below, let's briefly review basics of #Luminex testing & "cross-matching."

What/who is Luminex? 2/ In this #tweetorial, we'll answer 3Qs that help us assess a #kidneytransplant recipient's immunological risk:

1. Does this recipient have #DSA* (against HLA-antigens) ?
2. Can the antibodies bind?
3. Can the antibodies activate complement?

*DSA: donor specific antibodies

Starting the morning with “The Sciece of Learning” with Peter C Brown at the new #MedEd Workshop #KidneyWk

3 Big Ideas: Additional testing may be more effective than additional studying #MedEd #KidneyWk

1/ A short #tweetorial introducing human leukocyte antigen (HLA) and typing...an important and often confusing topic in #transplantation #kidneytransplant

#FOAMed @MedTweetorials

What is an "HLA"? 2/

HLAs = cell surface proteins encoded by highly polymorphic major histocompatibility complex (MHC) genes on Ch 6 🧬

In #transplantation, HLA proteins are #polymorphic antigens ➡️ alloreactive trigger for the immune response ➡️ can ultimately lead to organ #rejection ☠️

1/ Continuing the #immunosuppression #tweetorial series...@MedTweetorials

Today's player: #mTORi, mammalian/mechanistic target of rapamcyin inhibitors

Rapamcyin was @US_FDA approved for #kidneytransplant in 2003.

It was isolated from a soil sample from which island in 1975? 2/ Meet mTOR, a phosphatidylinositol 3-kinase (PI3)-related kinase (adds a phos). mTOR adds a phosphoryl group to serine/threonine residues.

It is a key component of the complexes mTORC1 and mTORC 2 - which regulate processes including cell growth, proliferation, and survival.

1/

Here's another #immunosuppression #tweetorial. This time, a focus on mycophenolic acid (MPA). #MMF #Mycophenolate

The main mechanism of action of MPA is inhibition of which of the following: 2/ Let's meet the players. Mycophenolate mofetil (MMF, left) is a prodrug of MPA while mycophenolate sodium (MPS, right) is an enteric-coated salt of MPA.

MMF administration releases MPA in the stomach, while mycophenolate sodium (MPS) releases it in the small intestine.

1/

A brief #tweetorial on the calcineurin inhibitors #CNI and their toxicities. Let's start with a quick poll.

Which of the following describes the main mechanism of action of #CNI? 2/

On to the mechanism of #CNI. Calcineurin inhibitors bind to the "immunophiliins" for which they are named. Cyclosporine (CsA) binds cyclophilin and tacrolimius(FK506) binds FK binding protein.

The CNI-immunophilin complex is the superhero which then inhibits calcineurin