2) Our guest faculty is @DrPallaviPrasad Assistant Prof Nephrology @SJHDelhi, India. This program is part of a foundational 🫘 #MedEd #accredited series hosted by core @ckd_ce faculty @sophia_kidney. pic.twitter.com/sihQLG4OVY
— @CKD_ce (@ckd_ce) January 24, 2024
4) .@ckd_ce offers multiple #accredited programs on #IgAN–✔️them out & earn MORE 🆓CE/#CME at https://t.co/jcyy2F0d6i, including a 🔑 #KidneyWeek23 update from @IgAN_JBarratt !
— @CKD_ce (@ckd_ce) January 24, 2024
6a) What are the recognised endpoints used to judge disease progression in #IgAN?
— @CKD_ce (@ckd_ce) January 24, 2024
1) Change in #eGFR (2x SCr, renal failure, or death)
2) #Proteinuria
3) Both of the above!
7) Putative risk factors for progression include:
— @CKD_ce (@ckd_ce) January 24, 2024
🧍 Clinical – MAP, Age, Race, obesity, 🚬, ?hematuria
🩸 Laboratory – #eGFR, #proteinuria, #dyslipidemia
🔬Biopsy markers- #MEST_C score
See https://t.co/wqDXdKKPrx pic.twitter.com/ws47XWDCLe
9) #RADAR #VALIGA #Toronto #GN cohorts:
— @CKD_ce (@ckd_ce) January 24, 2024
✴️ #UPCR over time➡️better predictor vs single value
✴️ Partial remission ➡️ ⬇️progression vs those w/ 24hUP >1g/d
✴️ Low grade #proteinuria also➡️#kidneyfailure; UPCR <0.88 g/g ➡️ >20% 🫘 failure in <10 y
But therapy🎯➡️COMPLETE REMISSION
11) On an individual patient level, the risk of disease progression can be estimated using the IgAN prediction tool (PT) now recommended by @GoKDIGO.
— @CKD_ce (@ckd_ce) January 24, 2024
Combines clinical + histopathology + laboratory parameters
🔓 https://t.co/djVQugMNvK
13a) Which of the following are modifications of #IgAN PT?
— @CKD_ce (@ckd_ce) January 24, 2024
1) IgAN PT in children
2) IgAN PT at 3 years post biopsy
3) IgAN PT in elderly
4) IgANPT in crescentic GN
14) Read blog on #IgAN PT for details regarding nuances of IgAN PT & its modifications@edgarvlerma @sayalithakre @paolo @nasim @hareshselvaskandan 👇
— @CKD_ce (@ckd_ce) January 24, 2024
🔓 https://t.co/WTLiyLLPVz
15b) The answer is 3: GFR trend in children w/ IgAN is initial ⬆️until adulthood, then⬇️in GFR
— @CKD_ce (@ckd_ce) January 24, 2024
Could be due to ⬆️🔥active lesions on bx & ⬇️ chronic lesions (⬆️response to therapy)
⚒️ IgAN PT in children is modified for outcome of 30% decline in #eGFR vs 50% decline in adults
17) #Complement activation markers in biopsy 🔬 are associated with progression
— @CKD_ce (@ckd_ce) January 24, 2024
✨Alternate pathway
C3 deposition associated with ⬆️ MEST-C score, ⬆️#IgAN PT accuracy
Glomerular FHR5 deposition
?? glomerular factor H
✨#Lectin pathway
Glomerular mannose binding lectin, C4d
19) Change in stool and tonsil microbiome a/w progression in IgA:
— @CKD_ce (@ckd_ce) January 24, 2024
🦠 Expansion of E coli- Shigella in gut
🦠 Neisseria in tonsil 👅
⚠️Large well planned studies are needed to establish clinical relevance
21) Noninvasive techniques for detecting renal fibrosis in #IgAN pic.twitter.com/gI3IMBUZ6f
— @CKD_ce (@ckd_ce) January 24, 2024
23) What’s needed in #biomarker research in #IgAN?
— @CKD_ce (@ckd_ce) January 24, 2024
⛔Validation in multiethnic
⛔Account for comorbidities & immunologic disease
⛔Account for spillage of proteins in urine & retention with⬇️ GFR
⛔Clinic level availability
⛔Incorporate in IgAN PT
⛔Answer post therapy dilemmas
25) Hope this applies to you after reading this tweetorial 👇
— @CKD_ce (@ckd_ce) January 24, 2024
Keep calm and keep learning👑 , till we meet again 👋
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