…IgA nephropathy (#IgAN) from the … perspective of the 2021 @goKDIGO #guidelines. Lots to learn about this common cause of #CKD worldwide! Free CE/#CME for #physicians #nurses #PAsDoThat #nursepractitioner @ANNAnurses @neph_PAs @pharmacists @nephondemand @IgAN_JBarratt
— @CKD_ce (@ckd_ce) November 15, 2021
1) Welcome! This #tweetorial will highlight some recommendations & practice points for the management of glomerular diseases that have been recently published by @goKDIGO
— @CKD_ce (@ckd_ce) November 16, 2021
Executive Summary https://t.co/ugoVsAkCMq
Full Guideline https://t.co/4jLrZvGyMK
I am @edgarvlermamd pic.twitter.com/BWkzLZRriC
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 https://t.co/PHlIppl6Yw.
— @CKD_ce (@ckd_ce) November 16, 2021
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 populationshttps://t.co/4jLrZvGyMK pic.twitter.com/4b0rtUcWjI
— @CKD_ce (@ckd_ce) November 16, 2021
6) First described over 5 decades ago by Jean Berger, it continues to be not only a diagnostic, but treatment dilemmahttps://t.co/rBEyugzc5T pic.twitter.com/j2gQDLcF5i
— @CKD_ce (@ckd_ce) November 16, 2021
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.
— @CKD_ce (@ckd_ce) November 16, 2021
10) #IgAN can only be diagnosed with a kidney biopsyhttps://t.co/4jLrZvGyMK pic.twitter.com/JtHgqp4PVH
— @CKD_ce (@ckd_ce) November 16, 2021
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 hypercellularityhttps://t.co/QKbcLjPJWv pic.twitter.com/IBVrOxpIgp
— @CKD_ce (@ckd_ce) November 16, 2021
14) There are many secondary causes of IgANhttps://t.co/znUcIKEy9x pic.twitter.com/lpPrvKPA4r
— @CKD_ce (@ckd_ce) November 16, 2021
— @CKD_ce (@ckd_ce) November 16, 2021
17) Let's see how this works. 48 year old, black ♂️, with an eGFR of 50ml/min/1.73m2 at the time of biopsy.
— @CKD_ce (@ckd_ce) November 16, 2021
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).
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!
— @CKD_ce (@ckd_ce) November 17, 2021
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 https://t.co/djVQugMNvK pic.twitter.com/EsCfDHmaYH
— @CKD_ce (@ckd_ce) November 17, 2021
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.
— @CKD_ce (@ckd_ce) November 17, 2021
25) Which biomarkers have been validated for IgAN?
— @CKD_ce (@ckd_ce) November 17, 2021
A. Serum Gd-IgA1 levels
B. Serum anti-glycan antibody
C. Serum levels of IgA-1 containing circulating immune complexes
D. Others https://t.co/KApeMatpTU
26) That was a trick question. There are no validated diagnostic serum or biomarkers for IgANhttps://t.co/4jLrZvGyMK https://t.co/bTGHfbgQ6j pic.twitter.com/wrsWoMOBCi
— @CKD_ce (@ckd_ce) November 17, 2021
28) In the @goKDIGO 2021 guidelines, mgt of IgAN focuses on non-immunosuppressive strategies (supportive care) to slow progression of the disease:
— @CKD_ce (@ckd_ce) November 17, 2021
– Rigorous BP control
– Optimal inhibition of RAAS
– Lifestyle mods (weight⬇️, exercise, smoking cessation, & dietary Na restriction) pic.twitter.com/rGR7zMX4p1
30) Welcome back to this discussion of #IgAN through the lens of the 2021 @goKDIGO #guidelines! I am @edgarvlermamd, you are earning CE/#CME credit, and now let's talk management of #hypertension in IgAN.
— @CKD_ce (@ckd_ce) November 18, 2021
32) Patients with IgAN who have proteinuria >0.5 g/d, irrespective of whether they have hypertension (Level 1B)https://t.co/4jLrZvGyMK pic.twitter.com/gkp8zmKBVb
— @CKD_ce (@ckd_ce) November 18, 2021
34) Immunosuppressive drugs should be considered only in patients with IgAN who remain at high risk of progressive CKD despite maximal supportive care https://t.co/4jLrZvGyMK
— @CKD_ce (@ckd_ce) November 18, 2021
https://t.co/4jLrZvGyMK
— @CKD_ce (@ckd_ce) November 18, 2021
Source of Figure https://t.co/A7w9yAbrGZ pic.twitter.com/1jOTkrpa8X
37) There are situations when glucocorticoids should be avoided, or administered with great cautionhttps://t.co/4jLrZvGyMK pic.twitter.com/rCp5EGg0jt
— @CKD_ce (@ckd_ce) November 18, 2021
39) . . . more adverse effects were observed among those who received immunosuppression, with no change in the rate of eGFR decline#VisualAbstract by @kidneybea_n https://t.co/WVuTIHIbLL pic.twitter.com/Co59qoHFjW
— @CKD_ce (@ckd_ce) November 18, 2021
41) Clinical benefit of glucocorticoids in IgAN is not established and should be given with extreme caution or avoided entirely in situations pic.twitter.com/AFHzXuT0DN
— @CKD_ce (@ckd_ce) November 18, 2021
43) Putting it all together (Immunosuppressive therapy) pic.twitter.com/zionBkpHz1
— @CKD_ce (@ckd_ce) November 18, 2021
45) What’s on the horizon as therapies that minimize or avoid glucocorticoid exposure?https://t.co/Dlyy3akIIvhttps://t.co/4jLrZvGyMK pic.twitter.com/dKp4W0SuBq
— @CKD_ce (@ckd_ce) November 18, 2021
— @CKD_ce (@ckd_ce) November 18, 2021
46) That's it! You just earned 0.5h CE/#CME credit and learned a heckuva lot about #IgAN while doing it! So (a) go to https://t.co/O4Kn4HkXRy to earn your credit and (b) FOLLOW @ckd_ce for more #tweetorial-based education about topics in CKD management! I am @edgarvlermamd.
— @CKD_ce (@ckd_ce) November 18, 2021