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🔺️Uremic pruritus: Most important piece of advice ‼Always ask your patients to trim their finger-nails‼ Otherwise you will end up with..... #Nephpearls #NephroNotes @NephJC @RenalFellowNtwk

💢Nephrotic syndrome #NephroNote 🔆Exceptions for renal biopsy in NS 🔺DM 🔺Child 1-10 yrs 🔺Frail elderly 🔺severe comorbidity

💢Nephrotic syndrome #NephroNotes 🔺Causes: Adults(USA) FSGS(35%) > MGN(33%) > MCD(15%) > MPGN 🔺Causes: Adults (India) FSGS(31%) > MGN(24%) > MPGN(18%) > MCD 🔺Causes: Children (India) MCD(77%) > FSGS(5%) > MesPGN > MPGN ‼️‼️Asian children 6 times higher risk NS c/f Europeans

💢Nephrotic syndrome #NephroNotes 👉Adults: Upto 4 L water and salt stay undetectable (revealed only by Weight) 👉Children: painless hepatomegaly ⚡️White banded nails (Muehrcke lines): correspond to period of hypoalbuminemia 👉Half and half nails: in persistent hypoalbuminemia

🌸Physical examination is incomplete without looking at nails‼️ 🔆Nail anatomy 🔆Nail involvement in medical disease 🔆Drug induced nail abnormalities 🔆Selection of mutations affecting nails Doi:10.3238/arztebl.2016.0509 #NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEdChat

🌸ALP ⬆️> 5x 👉Biliary cirrhosis 👉Biliary obstruction 👉Paget’s disease 👉Hyperparathyroidism 👉Osteogenic sarcoma ⬆️3-5x 👉IM 👉Granulomatous infiltration of liver 👉Metastatic bone tumor 👉Osteomalacia ⬆️<3x 👉Cirrhosis 👉Viral hepatitis 👉Pregnancy 👉Child #NephroNotes

🌸Division of labour in liver lobule 💡Blood flow & secreted morphogens give rise to spatially graded microenvironment, resulting in different functions assigned to different layers doi.org/10.1038/s41575-019-0… #FOAMed #MedTwitter #MedEd #NephroNotes

🔥Treatment in IgAN 👉Treatment options different in different clinical stages of IgAN 👉SGLT2i: New standard of care? 👉New treatment targets @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥Time point of renal biopsy during chronic course of IgAN is important to determine treatment strategy @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥IgAN- DIF findings & Clinical features 👉IgM deposition: ⬆️uPCR 👉IgA deposition: ⬆️% glomeruli with segmental sclerosis, crescents & hypercellularity score 👉IgG deposition: ⬆️% glomeruli with endocapillary proliferation @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥Multihit model of IgAN pathogenesis @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥What is the responsible mucosal site for pathogenesis of IgAN⁉️ 👉Overexpression of tonsillar TLR9 (involved in mech for GdIgA1 generation) 👉Abnormal expressions of specific IgA1 glycosyltransferases in tonsillar Bcell @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥TLRs play a critical role in early innate & mucosal immune responses to invading pathogens 🔥TLR9 plays critical role in pathogenesis of IgAN @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥Described 1st by Berger in 1968 based on “intercapillary deposits of IgA-IgG” 🔥Geographical variations 👉Genetic factors 👉Environmental factors @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥The phenotypic difference of IgA nephropathy dependent molecular mechanisms By Prof Hitoshi Suzuki @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥Prof Zhang concluded her presentation @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥Druggable genome may be promising with different value in different population @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥IgAN is pathological entity, but may be not single disease across world 🔥Genetics may be determinant in shaping severity 🔥Targeting treatment may differ b/w population @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥Higher prevalence of IgAN in Asian population with more severe clinical & pathological characteristics 👉Different genetic component 👉Heterogeneity of Gd-IgA1 & Complement in Asians & Europeans @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN

🔥Complement in IgAN 👉Mainly Alternative & Lectin pathway @aymwanghkuhk @ISNkidneycare #ISNwebinar #ThisIsISN