2a) This activity is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers. It is accredited for #physicians #physicianassistants #nurses #NPs #pharmacists. Check out @cardiomet_ce for more🆓CE/#CME.
— cardio-met (@cardiomet_CE) May 24, 2022
3) So let’s talk #histmed. Symptoms of #diabetes were recorded as far back as 400 BC.
— cardio-met (@cardiomet_CE) May 24, 2022
Sushruta, an Indian physician described diabetes in an ancient Hindi document as “madhumeha” or the honeyed-urine disease.
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5) As to modern epidemiology, the increasing prevalence of DKD (also referred to as diabetic #nephropathy) parallels the dramatic worldwide rise in prevalence of diabetes. In 2016, estimates of diagnosed diabetes prevalence varied across US counties, ranging from 1.5% to 33.0%.
— cardio-met (@cardiomet_CE) May 24, 2022
7) Diabetes is the number one cause of kidney failure in the US.
— cardio-met (@cardiomet_CE) May 24, 2022
It is responsible for fully 4⃣4⃣% of #KidneyDisease cases.https://t.co/iRILREODwo pic.twitter.com/nnsTjXc2W9
9) DKD risk factors can conceptually be classified as susceptibility factors (e.g., age, sex, race/ethnicity, family history), initiation factors (e.g., hyperglycemia, AKI), & progression factors (e.g., hypertension, dietary factors, obesity)
— cardio-met (@cardiomet_CE) May 24, 2022
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11) The natural history of diabetic kidney disease (#DKD) is best exemplified in patients with type 1 diabetes (#T1D) because the onset of #diabetes is more clearly definable and typically occurs at an early enough age to permit long-term follow-up.
— cardio-met (@cardiomet_CE) May 24, 2022
13) Patients with either T1D or T2D may exhibit an increased glomerular filtration rate (#GFR), so-called hyperfiltration, at the initial presentation of disease.
— cardio-met (@cardiomet_CE) May 24, 2022
15) Along with this changing paradigm of the natural history of #DKD, emerging evidence suggests that the clinical presentation of DKD is altering
— cardio-met (@cardiomet_CE) May 24, 2022
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17) Commissioned by the Research Committee of @Renalpathsoc an international consensus working group has provided a pathologic classification system (combining T1D and T2D #DKD) to address the heterogeneity of DKD presentation.
— cardio-met (@cardiomet_CE) May 24, 2022
19) Renal #biopsy at the time of onset of #microalbuminuria indicates glomerular and tubular basement membrane thickening and the inception of mesangial matrix expansion.
— cardio-met (@cardiomet_CE) May 24, 2022
🔓https://t.co/DfQ2Afp5lQ pic.twitter.com/sQHZbo4qzW
21) Although the Kimmelstiel–Wilson lesion is considered pathognomonic of advanced diabetic nephropathy, only approximately 25% of patients manifest this lesion. https://t.co/X2Oj4up1jd pic.twitter.com/PxSr98T5kr
— cardio-met (@cardiomet_CE) May 24, 2022
23) Mark your response and return TOMORROW for the correct answer and more #accredited education!@KIReports @NIDDKgov @ErinMichos @KatherineTuttl8 @polska_md @nephondemand @dguerrot
— cardio-met (@cardiomet_CE) May 24, 2022
And in case you missed it, here’s a good patient ed video for DKD: https://t.co/R5PH0Qmb1W
24b) Yesterday’s poll? If you didn’t vote yet, go back to tweet #22, don’t miss a chance to learn something, and JUST DO IT pic.twitter.com/DcwvzrhC5O
— cardio-met (@cardiomet_CE) May 25, 2022
26) Nodular glomerular lesions can also be observed in amyloidosis and membranoproliferative glomerulonephritis type 2.
— cardio-met (@cardiomet_CE) May 25, 2022
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28) The earliest clinical sign of the development of #DKD is usually the onset of microalbuminuria. https://t.co/X2Oj4uGCaL pic.twitter.com/tN3dS363vW
— cardio-met (@cardiomet_CE) May 25, 2022
30) Albuminuria is a dynamic, fluctuating condition rather than a linearly progressive process.
— cardio-met (@cardiomet_CE) May 25, 2022
32) Hyperglycemia & its metabolic sequelae are considered to be the proximate causative factor in development of diabetic #nephropathy. Hyperglycemia can induce numerous metabolic & structural abnormalities implicated in the pathogenesis of diabetic nephropathy, including …
— cardio-met (@cardiomet_CE) May 25, 2022
34) Although experimental studies have indicated that each of these alterations can be causative in animal models of diabetic nephropathy, their role in human diabetic nephropathy remains incompletely determined.
— cardio-met (@cardiomet_CE) May 25, 2022
36) What about renal #hemodynamics? Glomerular hyperfiltration is a well characterized consequence of early diabetes. Overall, it is observed in 10%–40% or up to 75% of patients with #T1D and up to 40% of patients with #T2D.
— cardio-met (@cardiomet_CE) May 25, 2022
38) Mechanisms underlying glomerular hyperfiltration in diabetes are incompletely understood; one plausible mechanism is⬆️proximal tubular reabsorption of glucose via #SGLT2, which⬇️distal delivery of solutes, particularly NaCl, to the macula densa.
— cardio-met (@cardiomet_CE) May 25, 2022
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40) The overall effect is high intraglomerular pressure and glomerular hyperfiltration.https://t.co/LhvdPq6J51 pic.twitter.com/za8QbYJdBD
— cardio-met (@cardiomet_CE) May 25, 2022
42) So what about screening for diagnosing #DKD? Screening should be performed annually for patients with #T1D beginning 5 years after diagnosis and annually for all patients with #T2D beginning at the time of diagnosis.https://t.co/X2Oj4up1jd pic.twitter.com/P7aJbXKAP1
— cardio-met (@cardiomet_CE) May 25, 2022
44) Welcome back! You are but a few 🖱️clicks away from free CE/#CME as @edgarvlermamd teaches us about the pathophysiology and lab assessment of diabetic #KidneyDisease #DKD. Join the fun and follow us! You'll also find great #tweetorials from @edgarvlermamd on @ckd_ce!
— cardio-met (@cardiomet_CE) May 26, 2022
46) While eGFR is a marker of kidney function that has historically been used to stage the severity of #CKD, albuminuria, as assessed by #UACR, is a measure of kidney damage.
— cardio-met (@cardiomet_CE) May 26, 2022
48) This study showed that if UACR is not available, predicted UACR from UPCR or urine dipstick protein may help in CKD screening, staging, and prognosis.#VisualAbstract by @AnnaGaddy
— cardio-met (@cardiomet_CE) May 26, 2022
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50) Over ½ of patients in the moderately increased and high-risk categories were classified into lower-risk categories using the dipstick test
— cardio-met (@cardiomet_CE) May 26, 2022
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52) A meta-analysis of 21 general population cohort studies (n=1,234,182; median follow-up of 7.9yr) found UACR ≥10 mg/g & eGFR <60 mL/min/1.73 m2 were significantly associated with an increased risk of CV mortality, independently of each other and of traditional risk factors.
— cardio-met (@cardiomet_CE) May 26, 2022
54) 3rd #NHANES (n=15,046) showed those w/CKD+T2D were at⬆️risk of 10y CV mortality, comp to T2D alone.
— cardio-met (@cardiomet_CE) May 26, 2022
Patients /CKD+T2D are 3x more likely to die of CV causes than with T2D alone.
CKD+T2D also⬆️risk of 10y all-cause mortality vs either alone.
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56) Albuminuria onset occurs sooner than a decline in GFR to levels <60 mL/min/1.73 m2, which may allow for earlier management of CKD progression.
— cardio-met (@cardiomet_CE) May 26, 2022
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58) These patients should be carefully monitored for the development of hyperkalemia in response to volume depletion or after the initiation of drugs that interfere with the renin angiotensin system, such as ACE inhibitors and ARBs.
— cardio-met (@cardiomet_CE) May 26, 2022
Artwork by @medcomic pic.twitter.com/kflRvK0PMP
60) Atypical features include
— cardio-met (@cardiomet_CE) May 26, 2022
– sudden onset of low eGFR or rapidly⬇️ing eGFR
– abrupt⬆️in albuminuria or development of nephrotic or nephritic syndrome
– refractory #hypertension
-signs/sx of another systemic disease
– >30% eGFR ⬇️within 2–3mo of initiation of a #RAASi pic.twitter.com/IRCOxcQjxo
61) And now you have made it! 🆓 CE/#CME! #Physicians #pharmacists #nurses #PAs: go to https://t.co/18fRWZPUjG and claim your credit! I am @edgarvlermamd. Follow @cardiomet_ce (& @ckd_ce) for more #tweetorials! #medtwittter #cardiotwitter #diabetickidneydisease #nephtwitter pic.twitter.com/vZPUkGYeXi
— cardio-met (@cardiomet_CE) May 26, 2022