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1/3 of lupus nephritis patient classified as "complete responders" continued to accrue progressive renal damage despite resolution of proteinuria over 1 year.
Dr. @andreafava reviews GFR trajectories after renal bx at #RNL2024 @RheumNow https://t.co/nYJZWw9jUL
Dr. Rachel Tate uptoTate ( View Tweet)
Myeloid and neutrophil degranulation is involved in disease activation of lupus nephritis. IL16 and CD163 are urinary biomarkers correlating with histologic disease activity “- Dr. @andreafava #RNL2024 @rheumnow https://t.co/YffIRy8B9u
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TheDaoIndex KDAO2011 ( View Tweet)
Urine proteomics in lupus nephritis
IL-16 and CD163 are urinary biomarkers most correlated w/ histologic activity
Myeloid & degranulation sign ass w histo activity -> PR3+cells abundant in LN
@andreafava #RNL2024 @RheumNow https://t.co/AVkZxPXkw3
Eric Dein ericdeinmd ( View Tweet)
@andreafava reviews options other than renal biopsy in the future of Lupus renal disease.
Urine proteomics can detect LN active pathways
IL-16, proinflammatory chemokine, linked to LN activity as potential new biomarker?
#RNL2024 @RheumNow https://t.co/GoEwu09npd
Dr. Rachel Tate uptoTate ( View Tweet)
Proteinuria does NOT correlate with intrarenal activity. Additionally, initial bx was not predictive of ESKD. Dr. Andrea Fava discusses need for second bx but difficulty doing so ie: it's invasive, it has risk, etc. #RNL2024 @RheumNow @andreafava https://t.co/1E5uuBGsO9
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Dr. Rachel Tate uptoTate ( View Tweet)
“90% of repeat biopsy will lead to change in treatment. Get the 2nd biopsy” – Dr. A Fava #RNL2024 @rheumnow https://t.co/wLaZelSeFo
TheDaoIndex KDAO2011 ( View Tweet)
@andreafava: 57% of pts w/ lupus nephritis are asymptomatic
Screen w/ proteinuria- but does NOT correlate w/ intrarenal disease
- Cannot differentiate classes, lagging indicator, does not distinguish inflammation from damage
87% repeat Bx lead to change in Rx
#RNL2024 @RheumNow https://t.co/de66VSKUG1
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Eric Dein ericdeinmd ( View Tweet)
“50% of pts with lupus nephritis are asymptomatic . You have to have a degree of kidney damage before you have proteinuria. Proteinuria does not correlate with intrarenal activity.” – Dr. A Fava #RNL2024 @rheumnow https://t.co/9aHmLG6VjA
TheDaoIndex KDAO2011 ( View Tweet)
ICYMI @eular_org 2023 SLE Treatment guidelines https://t.co/BkGhwQtSor @rheumnow #RNL2024 https://t.co/troJ9D6AGm
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TheDaoIndex KDAO2011 ( View Tweet)
Dr. Kahlenberg reviews the cycle of lupus. #RNL2024 @RheumNow @Kahlenberglab
Genetic > environmental > immune system activation > immunocomplexes > clinical disease https://t.co/Q7T9QpbFlm
Dr. Rachel Tate uptoTate ( View Tweet)
Don’t forget: complement activation by Abs form immune complexes resulting tissue destruction in different organs. - Dr. M Kahlenberg may use AVISE CTD to help determine if pts are in a flare @rheumnow #RNL2024 https://t.co/wdwtq1G3Sn
TheDaoIndex KDAO2011 ( View Tweet)
Clinical Pearl!
Lupus flare mimics with Dr. Kahlenberg
- FM
- Stress
- Infection
- Lack of sleep
- Iron deficiency
- Vitamin D deficiency
- Celiac or other concomitant inflammatory disease
- thyroid issues
@Kahlenberglab @RheumNow #RNL2024 https://t.co/4vEjmwTd3D
Dr. Rachel Tate uptoTate ( View Tweet)
Type I IFNs are a unique lupus feature.
- Increase class switching
- Repress TREGs
- Drive rash development
- DCs and B cells are more active
Look at the signature graph on the R hand side of the screen.
Dr. Kahlenberg #RNL2024 @RheumNow @Kahlenberglab https://t.co/zmClt9h3FW
Dr. Rachel Tate uptoTate ( View Tweet)
Pro tip from Dr. Kahlenberg with regard to B cell activation: Belimumab takes a long time to work because it doesn't deal with ab secreting cells, it just blocks making new ones. #RNL2024 @RheumNow @Kahlenberglab https://t.co/gFwPeEdGF6
Dr. Rachel Tate uptoTate ( View Tweet)
Would a wholistic B cell therapy, such as CAR-T, be more effective in Lupus?
We know B cell activation is important but belimumab may work better for short-lived B cells and RTX doesn't deplete most plasma cells.
CAR-T, targeting CD19, depletes all B cells. More research is… https://t.co/mPzKIfUC8p https://t.co/cGnI3dggqZ
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Dr. Rachel Tate uptoTate ( View Tweet)
The EULAR 2023 lupus flare guidelines (broken down here by renal and non-renal involvement) as reviewed by Dr. Kahlenberg. Remember to talk to patients about diet, adherence to treatment, skin protection, infection risk, vaccinations, blood glucose control, etc. #RNL2024… https://t.co/jUb04AFiA4 https://t.co/lATaUO75DA
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Dr. Rachel Tate uptoTate ( View Tweet)
Protips: Plasmablasts are made after B cell activation, making dsDNAAb & NMDA Ab that bind complement forming IC’s. A drug targeting plasmablast may be a better target. Belimumab may work better for short-lived B cell problems. – Dr. M Kahlenberg @rheumnow #RNL2024 https://t.co/vj6sRn4f7c
TheDaoIndex KDAO2011 ( View Tweet)
BAFF levels are high in patients lupus and allow for survival of autoreactive B cells. – Dr. M Kahlenberg on contributors to #SLE flares. #belimumab blocks BAFF but takes a long time to work, consider adding something faster active like steroids. @rheumnow #RNL2024 https://t.co/QGTcAgqjSN
TheDaoIndex KDAO2011 ( View Tweet)
T cells are important in SLE flares (but are not the only player) - Dr. M Kahlenberg @rheumnow #RNL2024 https://t.co/xFeYrKHnGi
TheDaoIndex KDAO2011 ( View Tweet)
Treatment of SLE. EULAR guidelines via @Kahlenberglab @RheumNow #RNL2024 https://t.co/a5lWfRLuh3
Richard Conway RichardPAConway ( View Tweet)