2) Follow this 🧵for .75hr 🆓CE/#CME. This program supported by an independent education grant from Travere. Statement of accreditation & faculty disclosures at https://t.co/PHlIppl6Yw.— @CKD_ce (@ckd_ce) October 10, 2023
And FOLLOW US for the best expert-led #MedEd in #nephrology, delivered entirely on X !
4) Although #IgAN is characterized by a single histopathologic criterion of predominant or codominant IgA deposits on #kidney #biopsy, it is now well recognized that this “disease” exhibits marked heterogeneity in its clinical and pathological features— @CKD_ce (@ckd_ce) October 10, 2023
5b) 🔬confirmed focal subacute #glomerulonephritis (type Berg) with IgA precipitate on the glomerular mesangium & Bowmann's capsule. This is 1st documented case in which the subacute IgA #glomerulonephritis could be confirmed immunohistochemicallyhttps://t.co/dYD8PxgCdQ— @CKD_ce (@ckd_ce) October 10, 2023
6b) #IgAN is relatively rare in individuals of African descent.— @CKD_ce (@ckd_ce) October 10, 2023
It is unclear if these observations are due to differences in pathogenesis and/or the contribution of varying genetic and environmental influences.https://t.co/4jLrZvGyMK
7b) Subsequent deposition of circulating IgA-containing immune complexes in the glomerular #mesangium instigates several injury pathways, resulting in glomerular #inflammation & #fibrosis. The "hits" are explained in more detail by @nephondemand at https://t.co/aWs58y38aS.— @CKD_ce (@ckd_ce) October 10, 2023
8a) So what do you know? How does #IgAN manifest clinically?— @CKD_ce (@ckd_ce) October 10, 2023
14) See Practice Point 2.1.1: Considerations for the diagnosis of #IgAN:— @CKD_ce (@ckd_ce) October 10, 2023
– IgAN can only be diagnosed with a kidney biopsy.
– There are no validated diagnostic serum or urine biomarkers for IgAN.
– Assess all patients with IgAN for secondary causeshttps://t.co/4jLrZvGyMK pic.twitter.com/tAnNXPj1PW
17) Importantly, MEST-C score was developed to predict outcome, not to guide tx or predict response.— @CKD_ce (@ckd_ce) October 10, 2023
Other scores predict outcomes in #IgAN. Earlier scores included pathologic classification schema in cohorts of uniform racial/geographic origin.https://t.co/4jLrZvGyMK pic.twitter.com/pl07bbMbfu
18b) The International #IgAN Prediction Tool quantifies risk of progression & ands inform shared decision-making with pts. It incorporates clinical info at the time of #biopsy & cannot be used to determine the likely impact of any particular tx regimen.https://t.co/4jLrZvGyMK pic.twitter.com/RPrNcb9LcQ— @CKD_ce (@ckd_ce) October 10, 2023
19b) Future work will be required to determine if clinical data measured more remotely from the time of biopsy can be used in a similar manner.— @CKD_ce (@ckd_ce) October 10, 2023
You can click this link for the calculator:https://t.co/FfgkRxTcO1
21) Let's pause here and do a quick knowledge ✅. Which of the following is NOT a component of effective lifestyle modification in pts with #IgAN?— @CKD_ce (@ckd_ce) October 10, 2023
a. weight reduction
b. smoking cessation
c. dietary sodium restriction
d. dietary potassium restriction
23) Welcome back!! @ckd_ce & expert author @edgarvlermamd 🇵🇭 are glad u have returned! We'll keep talking about #primarycare management of #IgAN. We were at lifestyle mod & we left u w/ a ❓yesterday (tweet 21). The correct answer was d; a-c are useful; ⬇️K intake is not needed.— @CKD_ce (@ckd_ce) October 11, 2023
25b) Variant forms of #IgAN: IgA deposition with minimal change disease (#MCD), IgAN with acute kidney injury (#AKI), and IgAN with rapidly progressive glomerulonephritis (#RPGN) may require specific immediate treatmenthttps://t.co/4jLrZvGyMK pic.twitter.com/xpLl1w4p4l— @CKD_ce (@ckd_ce) October 11, 2023
29) The mainstays of tx are diuretics + moderate dietary Na restriction (1.5–2 g/d or 60–90 mmol/d).— @CKD_ce (@ckd_ce) October 11, 2023
Nephrotic pts often #diuretic resistant, even if GFR is normal.
Loop diuretics are first-line in tx'ing nephrotic edema; BID usually preferredhttps://t.co/4jLrZvGyMK pic.twitter.com/btEXway8es
30b) Combining a loop diuretic with a #thiazide-like #diuretic (hydrochlorothiazide, metolazone, chlorthalidone) can be an effective oral regimen to overcome diuretic resistance, by blocking sodium resorption at several sites within the #nephronhttps://t.co/4jLrZvGyMK pic.twitter.com/GCe40BU6vg— @CKD_ce (@ckd_ce) October 11, 2023
31b) Lifestyle modification (salt restriction, weight normalization, regular exercise, reduction in alcohol intake, and smoking cessation) should be an integral part of the therapy for BP controlhttps://t.co/4jLrZvGyMK pic.twitter.com/FeBAaDX8D1— @CKD_ce (@ckd_ce) October 11, 2023
32b) Alert! 🚨— @CKD_ce (@ckd_ce) October 11, 2023
Be on the lookout for substantial advances in approach to reducing proteinuria in #IgAN with so-called #DEARA: Dual Endothelin Angiotensin Receptor Antagonist agents. #Sparsentan is 1st to be approved & you can learn about it & earn even more 🆓#MedEd credit . . .
33a) The antiproteinuric agents of choice are angiotensin converting enzyme inhibitors (#ACEi) or angiotensin II receptor blockers (#ARBs), which may ⬇️proteinuria by up to 40%–50% (dose-dependent), esp if pt complies with dietary 🧂restriction— @CKD_ce (@ckd_ce) October 11, 2023
33c) Do not stop #ACEi or #ARB for modest & stable increase in serum creatinine (up to 30%)— @CKD_ce (@ckd_ce) October 11, 2023
Stop🛑ACEi or ARB if #kidney function continues to worsen, and/or the patient develops refractory hyperkalemiahttps://t.co/4jLrZvGyMK pic.twitter.com/gZGIw8QZyO
35) Uptitrating the dose is indicated in those with persistent #proteinuria despite treatment of the primary #GN with #immunosuppression (where indicated)— @CKD_ce (@ckd_ce) October 11, 2023
Avoid the use of an #ACEi or #ARB if the function is rapidly changinghttps://t.co/4jLrZvGyMK pic.twitter.com/025NAuWJSF
41) Here is an algorithm on how to monitor and manage acute changes in #kidneyfunction related to the use of #ACEi or #ARB and how to follow up#Nephpearls #VisualGraphic by @CaliceViviane @DrSumanBeherahttps://t.co/MBvG6HJSLA pic.twitter.com/YC6kmKgX62— @CKD_ce (@ckd_ce) October 11, 2023
43c) Tx of #hyperlipidemia in pts with NS may follow the guidelines for general population, tho demonstration of #CV event ⬇️ or #QoL ⬆️ is lacking in patients with hyperlipidemia from glomerular dz or its tx.https://t.co/4jLrZvGyMK pic.twitter.com/MHf7tafdDk— @CKD_ce (@ckd_ce) October 11, 2023
44b) Care is needed when statins are used in combination with other drugs; there is an increased risk of myalgia/myositis when statins are combined with #CNI— @CKD_ce (@ckd_ce) October 11, 2023
45) As previously mentioned, dietary restriction of Na to < 2.0 g/day (<90 mmol/day) is a primary tenet for control of BP & edema (especially in the nephrotic patient) & to improve urinary protein excretion independently of meds that ⬇️proteinuriahttps://t.co/4jLrZvGyMK pic.twitter.com/H8RVbsA4WS— @CKD_ce (@ckd_ce) October 11, 2023
47) Calorie restriction in pts w/⬇️ GFR & #BMI > ideal is rec'd to facilitate wgt loss & prevent #CV & #kidney complications (i.e., faster rate of progression of CKD and kidney failure).— @CKD_ce (@ckd_ce) October 11, 2023
Pts w/ #GFR <60 ml/min per 1.73 m2 should consume 30–35 kcal/kg/dayhttps://t.co/4jLrZvGyMK pic.twitter.com/1391P2QZLj
49a) Adults and children with #GN & #NS (and #CKD in general) are at ⬆️risk of invasive #pneumococcal infection. They & their household contacts should receive pneumococcal #vaccination w/ heptavalent conjugate vaccine (#7vPCV) . . .— @CKD_ce (@ckd_ce) October 11, 2023
49c) Vaccination with live #vaccines (measles, mumps, rubella, varicella, rotavirus, yellow fever) is contraindicated while on immunosuppressive or cytotoxic agents . . .— @CKD_ce (@ckd_ce) October 11, 2023
50a) In women of childbearing potential, the risks of #pregnancy on the patient, on the fetus, and on the underlying #kidneydisease must be considered.— @CKD_ce (@ckd_ce) October 11, 2023
The care of pregnant patients with #GN requires coordination & planning with #OBGYN & #MFM.
51) #Contraception is also an important consideration.#ACEi and #ARB and many #GN therapies are known to be Category X (potentially #teratogenic or #embryotoxic) medications.https://t.co/4jLrZvGyMK pic.twitter.com/6E23y17Etn— @CKD_ce (@ckd_ce) October 11, 2023
54) In a pre-specified analysis of the #DAPA_CKD trial, particularly in participants with #IgAN, dapagliflozin was shown to reduce the risk of CKD progression with a favorable safety profile #Nephpearlshttps://t.co/44VCWihHCw pic.twitter.com/LgK7a0Km4D— @CKD_ce (@ckd_ce) October 11, 2023
58) There are many new developments in the mgmt of #IgANspace; ✔️this “modified” @goKDIGO algorithm ca. 2022 from @CJASN @ReichHeather & Jurgen Floegehttps://t.co/rtzFFlZo29 pic.twitter.com/12Wf7HMtsU— @CKD_ce (@ckd_ce) October 11, 2023
60) And you just earned 0.75hr 🆓CE/#CME! Whew! Let your 🖱️ take you to https://t.co/MeoS08pqe9 to claim your certificate! @edgarvlermamd thanks you for joining! And look for an update on #IgAN from #ASN23 authored by @IgAN_JBarratt, coming soon!— @CKD_ce (@ckd_ce) October 11, 2023
Follow @ckd_ce for more #MedEd!