. . . and tell your colleagues to join you here on @ckd_ce, your ONLY source for accredited #tweetorials in the #CKD space! #nephtwitter @IgAN_JBarratt @ChristosArgyrop @goKDIGO @nicklimd @CKJsocial @ERAkidney @kidneypathology pic.twitter.com/QGbWSYKICd
— @CKD_ce (@ckd_ce) December 6, 2021
2) The @ckd_ce program is supported by educational grants from Travere, Bayer, and Otsuka. This program is intended for healthcare providers. Faculty disclosures can be found at https://t.co/PHlIppl6Yw. Follow us here for #accredited #tweetorials by #experts in #nephrology!
— @CKD_ce (@ckd_ce) December 7, 2021
4) Hit 1: ⬆️levels of galactose-deficient IgA1. Gd-IgA1 is an autoantigen. Hit 2 occurs when antibodies are produced against Gd-IgA1. Immune complexes are formed (Hit 3). Hit 4 is deposition of those immune complexes in the kidney w/ complement activation & subsequent injury. pic.twitter.com/7wJm2yeBgu
— @CKD_ce (@ckd_ce) December 7, 2021
6) Despite this hypothesis, we still don’t have highly reliable diagnostic markers in the serum or urine. Diagnosis is still made by #biopsy. Once made, rule out common secondary causes of IgAN: HIV, inflammatory bowel disease, autoimmune diseases, cirrhosis, and . . . pic.twitter.com/zP1Ms3mkEM
— @CKD_ce (@ckd_ce) December 7, 2021
8) Once you’ve got tissue, score using the MEST-C. MEST-C helps you prognosticate the likelihood for developing ESRD. pic.twitter.com/ex1vThGiZj
— @CKD_ce (@ckd_ce) December 7, 2021
10) Even better is that the tool is truly “international”: you can use it for non-American patients. Use the online tool here: https://t.co/UpDNLknmwu pic.twitter.com/juWnsPBEy4
— @CKD_ce (@ckd_ce) December 7, 2021
12) Mark your answer and return tomorrow for the correct response and more education! You are earning FREE CE/#CME! @kdjhaveri @NWiegley @SusanQuaggin @divyaa24 @neph_mo @kidneydrpanama @KOBPharmD @annetkiraboc1 @dr_missyhanna @NadaAlachkar @RenalProgram @HollyMLoughton
— @CKD_ce (@ckd_ce) December 7, 2021
14) Now that you’ve made the diagnosis of IgAN and have an idea of the prognosis, what treatment options do you have?
— @CKD_ce (@ckd_ce) December 8, 2021
First, consider the “standard” antiproteinuric agents within the renin-angiotensin-aldosterone blocking family.
16) In the late 2000s, #steroids were considered the mainstay of treatment above-and-beyond #RAAS inhibition. STOP-IgA and TESTING (high-dose) had called that belief into question. pic.twitter.com/0scuCE0IQq
— @CKD_ce (@ckd_ce) December 8, 2021
18) STOP-IgA was considered a negative trial because steroids did not prevent #eGFR decline by more than 15.
— @CKD_ce (@ckd_ce) December 8, 2021
20) A 10-year follow-up of the patients in the STOP-IgA trial showed no benefit of steroid use in mitigating the progression towards #ESRD. pic.twitter.com/esZCq4DrXk
— @CKD_ce (@ckd_ce) December 8, 2021
22) This resulted in another look at TESTING –> TESTING (2021). TESTING (2021) used a reduced-dose of steroids and added antibiotic prophylaxis. These data were presented at the @ASNKidney 2021 meeting. pic.twitter.com/z8jTIyGNlW
— @CKD_ce (@ckd_ce) December 8, 2021
24) Some (not this author) believe steroids are back in the treatment of #IgAN. I think there are better options worth considering and pursuing. One of those better options: #SGLT2 inhibitors. For example, in the DAPA-CKD study, a total of 270 patients had #IgAN. pic.twitter.com/Fc9ti0wm4y
— @CKD_ce (@ckd_ce) December 8, 2021
26) Next on the list of potential therapeutics: #budesonide. This is an oral steroid that works at in the lymphoid tissue of the intestinal tract. It is thought that anti-Gd-IgA1 antibodies are formed in this location.
— @CKD_ce (@ckd_ce) December 8, 2021
28) The secondary outcome for NEFIGAN was change in eGFR; both doses of budesonide showed a stabilization in the loss of GFR. pic.twitter.com/zH1xP5zydf
— @CKD_ce (@ckd_ce) December 8, 2021
30) There’s one more class to consider: the #endothelin receptor antagonists. Join us tomorrow and we’ll give those a quick review and lead you to your FREE CE/#CME credit! And please check out past programs, with credit still available, at https://t.co/8lmzd7ADnj!
— @CKD_ce (@ckd_ce) December 8, 2021
32) Finally, a quick shoutout to the endothelin receptor antagonists (the "sentan"s). Interim data from PROTECT suggest a greater reduction in #proteinuria compared to #irbesartan. Endothelin receptor antagonists can help increase #podocyte survival. pic.twitter.com/O7zscixZwy
— @CKD_ce (@ckd_ce) December 9, 2021
34) In summary, we have few options to treat our #IgAN patients. #RAASi and possibly steroids (depending on your perspective) are options. Hydroxychloroquine in the right patient population (? Asians only). If you're fortunate, you can refer to one of the many ongoing trials. pic.twitter.com/B5XhwUFdWT
— @CKD_ce (@ckd_ce) December 9, 2021
36) And that's it! You just earned 0.5h CE/#CME credit! Claim it at https://t.co/55htuHiHCz. I am @nephondemand. FOLLOW US for more FREE accredited #tweetorials from expert authors! #NephTwitter #Nephrology @MedTweetorials #FOAMed @NephUCommunity @ASNKidney
— @CKD_ce (@ckd_ce) December 9, 2021