Immune checkpoint inhibitors and the Kidney infographic

 

Here is a comprehensive infographic by Tejas Desai on 4 studies from around the world with ICI and the Kidney. 

Topic Discussion: SGLT2i and the Kidney

 

Post Grand Rounds SLGT2i and the Kidney Tweetorial
- The Glucoretics - thanks @edgarvlermamd @ChristosArgyrop @jam_hirsch for some slides
Start...PART 1 https://t.co/rXn5AqYinO

— Kenar Jhaveri (@kdjhaveri) May 28, 2021

SLGT2i and the Kidney Tweetorial Part 2
Start: Time to #flozinate
When prescribing- mindful for bp management https://t.co/OD5WOYOYv0 @aishaikh pic.twitter.com/PDqCo1vJK2

— Kenar Jhaveri (@kdjhaveri) May 28, 2021

Two tweetorials I had recently done on the benefits of SGLT2 inhibitors

Here is a table summary of what exists on benefits of various things in Nephrology

SGLT2i  benefit	Summary or Major Reference
Diabetic Kidney Disease	https://onlinelibrary.wiley.com/doi/full/10.1002/clc.23508
IgA Nephropathy	https://www.kidney-international.org/article/S0085-2538(21)00396-3/fulltext
SIADH	https://jasn.asnjournals.org/content/31/3/615.abstract
Hypomagnesemia	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380494/
Kidney Stones Prevention	https://link.springer.com/article/10.1007/s00125-021-05424-4
Anemia of CKD	https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30300-4/fulltext
Prevent AKI	https://cjasn.asnjournals.org/content/16/1/70.abstract
Prevention of cisplatin AKI	https://journals.physiology.org/doi/full/10.1152/ajprenal.00512.2019

 

COVID19 vaccine induced glomerular diseases?- a literature update May 2021

The vaccine for COVID19 has been a lifesaver for many around the world. As expected, as you upregulate your immune system- you are going to get some flare ups of your immune system. Thus far, what are we noticing Minimal change disease, MN and IgA nephropathy. 

Several published cases of podocytopathies- mainly minimal change disease- either de-novo or relapse have been reported ( 4 cases thus far)

https://www.kidney-international.org/article/S0085-2538(21)00493-2/fulltext (Pfizer-BioNTech )

https://www.sciencedirect.com/science/article/pii/S0272638621005096 (Pfizer-BioNTech) 

https://www.ajkd.org/article/S0272-6386(21)00602-8/fulltext ( Pfizer-BioNTech )

https://www.kidney-international.org/article/S0085-2538(21)00478-6/fulltext (Pfizer-BioNTech)

IgA nephropathy flaring up has been reported ( 3 cases thus far)

https://www.kidney-international.org/article/S0085-2538(21)00465-8/fulltext ( Moderna)

https://www.kidney-international.org/article/S0085-2538(21)00286-6/fulltext (Moderna)

Relapse of Membranous Nephropathy  ( one case)

https://www.kidney-international.org/article/S0085-2538(21)00494-4/fulltext (Sinovac’s COVID-19 vaccine.)

Acute transplant rejection has been reported

https://www.kidney-international.org/article/S0085-2538(21)00466-X/fulltext ( Pfizer-BioNTech)

While we cannot be totally sure if this is vaccine related- timing maybe a factor. I am sure there will be many more to be added to this list.

Despite this, the vaccine saves lives! Remember severe COVID19 disease led to significant AKI and ATN and even several cases of glomerular diseases. Such vaccine associated immune responses should not deter one from getting vaccinated. Overall, even the flu vaccine and other vaccines have been associated with several glomerular diseases such as MCD and membranous nephropathy.  Given mass vaccinations happening around the world, there will be cases of vaccine induced GNs( but still very very rare)

Detective Nephron: Next venture

 

https://www.kidneynews.org/view/journals/kidney-news/13/5/article-p12_4.xml

Concept Map: Infections and Renal Transplant

 

Based on a recent article in CJASN by Agrawal et al.

Figure made using biorender.com 

Hypophosphatemia with anti-cancer agents

 

Here is a schematic of what we know for now in 2021 in relation to anti cancer agents leading to low phosphorus. This was made using biorender.com and inspired by the article Adhikari et al. 

In the NEWs: Hydralazine and the Kidney

Hydralazine- you can love or hate as a nephrologist. Hydralazine is used a lot for both inpatient and outpatient setting my several internists, cardiologists and nephrologists for management of blood pressure. In clinical practice, many times we have noticed vasculitis from hydralazine : both of the lupus or the ANCA kind. Drug induced kidney diseases are important to keep in mind when the clinical picture doesn't make any sense. 

See this exhaustive table from Izzedine and Ng in the recent Kidney News issue on drug induced glomerular diseases. 

A recent study in KI just focused on hydralazine induced ANCA vasculitis and looked at 80 patients.
As suspected, the clinical clues are: many have low complements, +ANCA( both p and c in some cases- 40%), ANA and anti histone positive and even dsDNA positive. When you see several auto antibodies come back positive- think drug induced. Treatment is cessation of the agent and treat like regular vasculitis. 

Check out an old detective nephron from 2013 on this topic.