2) This activity is accredited for #physicians #physicianassistants #nurses #NPs #pharmacists. Past programs still eligible for credit are at https://t.co/8lmzd7ADnj. Accreditation statement & faculty disclosures at https://t.co/PHlIppl6Yw. Your expert author is @edgarvlermamd. pic.twitter.com/CmnPquUpsf
— @CKD_ce (@ckd_ce) September 28, 2022
4) Around 150 AD, the Greek physician Aretaeus of Cappadocia (attention #histmed geeks, see 🔓https://t.co/cmDMqJXfyd) wrote this about diabetes: pic.twitter.com/VSkjFXhmVz
— @CKD_ce (@ckd_ce) September 28, 2022
6) The median county-level prevalence of diagnosed diabetes ↗️↗️ from 7.8% in 2004 to 13.1% in 2016.https://t.co/Y0C4IPkTgJ pic.twitter.com/DArMenDuiS
— @CKD_ce (@ckd_ce) September 28, 2022
8) The driving force behind the escalating prevalence of diabetes is the global pandemic of obesity 🔓https://t.co/TQgSBY4l5y pic.twitter.com/mYKKqnXb07
— @CKD_ce (@ckd_ce) September 28, 2022
10) Two of the most prominent established risk factors are #hyperglycemia and #hypertension. pic.twitter.com/E8TsDluvTU
— @CKD_ce (@ckd_ce) September 28, 2022
12) Note that #T1D usually afflicts a younger population that do not usually initially have comorbid conditions (#hypertension, #ASCVD, #obesity, etc.) often associated with #T2D and that may independently produce #CKD.
— @CKD_ce (@ckd_ce) September 28, 2022
🔓https://t.co/jYo8HcdOZB pic.twitter.com/nfHGhlLO6C
14) This hyperfiltration is mediated by proportionately greater relaxation of the afferent arteriole than the efferent arteriole and results in increased glomerular blood flow and elevated glomerular capillary pressure.https://t.co/oDTK9hP6Dk pic.twitter.com/37gOIdhbML
— @CKD_ce (@ckd_ce) September 28, 2022
16) Let's talk🥼pathology. An early finding in patients with poorly controlled diabetes is enlargement of the kidneys, which represents predominantly hypertrophy of the existing structures rather than growth of new #nephrons or cellular hyperplasia.
— @CKD_ce (@ckd_ce) September 28, 2022
18) This system included scoring of 🔬 glomerular, interstitial, & vascular lesions.
— @CKD_ce (@ckd_ce) September 28, 2022
DKD was divided into 4 hierarchical glomerular lesions with a separate evaluation for degrees of interstitial and vascular involvement.
🔓https://t.co/OEHokeUvIQ pic.twitter.com/ejswAN9AZ7
20) Renal biopsy in patients who develop overt #proteinuria reveals diffuse or nodular (#Kimmelstiel_Wilson) #glomerulosclerosis. https://t.co/jZyNrInAA1 pic.twitter.com/oXAlQdwShm
— @CKD_ce (@ckd_ce) September 28, 2022
22) What other diseases cause a nodular pattern of glomerulopathy?https://t.co/ofsLfOCV8U Amyloidosis
— @CKD_ce (@ckd_ce) September 28, 2022
B.AA Amyloidosis
C.Monoclonal Ig Deposition Disease (MIDD)
D.All of the above
24a) Welcome back! Expert author @edgarvlermamd is providing foundational knowledge on the evaluation & staging of #CKD in patients with #T2D. And YOU are earning CE/#CME! Nods to @GoggleDocs @LangoteAmit @divyaa24 @ChristosArgyrop @mvaduganathan @AgarwalRajivMD @VelezNephHepato
— @CKD_ce (@ckd_ce) September 29, 2022
25) A nodular pattern of glomerulopathy mimicking Kimmelstiel-Wilson lesions may also be seen in light chain nephropathy. Historic descriptions of “diabetic nephropathy without overt hyperglycemia” based solely on light microscopy actually may have been light-chain disease.
— @CKD_ce (@ckd_ce) September 29, 2022
27) #Microalbuminuria is more likely in patients who also have evidence of other microvascular insults, especially proliferative #retinopathyhttps://t.co/oDTK9hP6Dk pic.twitter.com/DSgeSuXWwO
— @CKD_ce (@ckd_ce) September 29, 2022
29) Initially, transient or intermittent #microalbuminuria can be measured by radioimmunoassay, enzyme-linked immunosorbent assay, or special dipsticks, especially when induced by stress, physical exertion, concurrent illness, or poor #glycemic control.
— @CKD_ce (@ckd_ce) September 29, 2022
31) So let's move now to pathobiology. Critical metabolic changes that alter kidney hemodynamics and promote inflammation and fibrosis in early diabetes include hyperaminoacidemia, a promoter of glomerular hyperfiltration and hyperperfusion, and #hyperglycemia. pic.twitter.com/vDbq3kQzwG
— @CKD_ce (@ckd_ce) September 29, 2022
33) ..generation of reactive oxygen species, activation of the polyol pathway (leading to de novo synthesis of diacylglycerol & increased protein kinase C activity), alterations in the hexosamine pathway, & nonenzymatic protein glycation (advanced glycosylation end products).
— @CKD_ce (@ckd_ce) September 29, 2022
35) Better glucose control does generally reduce the risk of nephropathy and other microvascular complications, especially in type 1 diabetes #T1Dhttps://t.co/jZyNrInAA1 pic.twitter.com/kJFwRlFS5V
— @CKD_ce (@ckd_ce) September 29, 2022
37) In T2D, systemic #hypertension and #obesity also contribute to glomerular hyperfiltration via various mechanisms, such as high transmitted systemic BP and glomerular enlargement.https://t.co/f7ng5jzw4s pic.twitter.com/1ybc4raYOz
— @CKD_ce (@ckd_ce) September 29, 2022
39) The resulting⬇️in tubuloglomerular feedback may dilate the afferent arteriole to⬆️glomerular perfusion, while concurrently, high local production of angiotensin II at the efferent arteriole produces vasoconstriction.
— @CKD_ce (@ckd_ce) September 29, 2022
41) There's even more to the #pathophysiology of #DKD: #DM causes overactivation of the mineralocorticoid receptor, which⬆️the expression of proinflammatory cytokines & profibrotic proteins, leading to inflammation & fibrosis.
— @CKD_ce (@ckd_ce) September 29, 2022
🔓https://t.co/Jvb7kT85wR pic.twitter.com/YLqDAEY5AD
43) So re making that diagnosis, mark your choice below and return tomorrow for the correct answer, the rest of the education in this #tweetorial, and your CE/#CME credit grab!
— @CKD_ce (@ckd_ce) September 29, 2022
The diagnosis of DKD requires which of the following:
45) The clinical diagnosis of DKD is on the basis of measurement of #eGFR and #albuminuria along with clinical features, such as diabetes duration and presence of diabetic #retinopathy.https://t.co/oDTK9hxveK pic.twitter.com/JhNMBLPlJ0
— @CKD_ce (@ckd_ce) September 30, 2022
47) The preferred test for albuminuria is a urinary albumin-to-creatinine ratio (#UACR) performed on a spot sample, preferably in the morning.
— @CKD_ce (@ckd_ce) September 30, 2022
49) Urine dipstick underestimates #CKD risk as compared with #UACR.
— @CKD_ce (@ckd_ce) September 30, 2022
Data from an analysis of the Korean #NHANES 2011-2014 among adults at least 20 years of age with available urinalysis data (n=20,759).
51) #DKD is identified clinically by persistently high #UACR ≥30 mg/g and/or sustained reduction in #eGFR <60 ml/min per 1.73 m2 pic.twitter.com/ZPQiobsisc
— @CKD_ce (@ckd_ce) September 30, 2022
53) The mortality gradient conferred by higher albuminuria within all but the lowest eGFR category was > 2x.
— @CKD_ce (@ckd_ce) September 30, 2022
This was > the risk between adjacent CKD stages based on eGFR, suggesting that albuminuria provides > prognostic information beyond eGFR.
🔓https://t.co/rfss5YN1tO pic.twitter.com/Vr23QTaXG4
55) Both #UACR and #eGFR are recommended by guidelines for identification of #CKD progression in patients with #T2D.
— @CKD_ce (@ckd_ce) September 30, 2022
Confirmation of albuminuria or low eGFR requires 2⃣ abnormal measurements at least 3⃣ months apart. pic.twitter.com/094Nm9CGcr
57) Patients with diabetes also experience an increased rate of other kidney abnormalities.
— @CKD_ce (@ckd_ce) September 30, 2022
Type 4 (hyporeninemic, hypoaldosteronemic) metabolic acidosis with hyperkalemia is commonly encountered in patients with diabetes and mild to moderate renal insufficiency.
59) If features atypical of #DKD are present, then other causes of kidney disease should be considered. https://t.co/oDTK9hxveK
— @CKD_ce (@ckd_ce) September 30, 2022
61) And now you have made it! 🆓CE/#CME! #Physicians #pharmacists #nurses #PAs: go to https://t.co/vHOYjuIEEm and claim your credit! I am @edgarvlermamd. Follow @ckd_ce (& @cardiomet_CE) for more #tweetorials! #medtwittter #cardiotwitter #FOAMed #nephtwitter
— @CKD_ce (@ckd_ce) September 30, 2022