Nick Medjeral-Thomas

Incredible work by @jack_gisby , Jimmy Peters and many others @ImperialImmuno @imperialcollege @ImperialNHS renal and transplant centre @clclarke227 @mkwillicombe elifesciences.org/articles/64827

This describes our experience managing #haemodialysis patients with #COVIDー19 @ImperialNHS community dialysis unit incl risk factors for deterioration and (zero) staff infections #relatedArticles" target="_blank" rel="nofollow noopener">kireports.org/article/S2468-…

Pleased to see our paper available preprint. Huge collaborative effort from clinicians, scientists, dialysis nurses and patients @imperialcollege @ImperialImmuno @ImperialNHS @mkwillicombe @Maria_Prend @stephenmcadoo @NickRhysMT

Proud to be part of this huge effort from scientists and clinicians to detail longitudinal proteomic profiles of end-stage kidney disease patients with #COVID19 #medRxiv @ImperialImmuno @ImperialNHS @clclarke227 @jack_gisby medrxiv viewer disq.us/t/3splu24

Thank you for hosting @NephJC #NephJC

@HotKidneyAction @NephJC Was a multicentre trial - No difference in findings in non-Imperial College vs Imperial College patients #NephJC

@NephJC I can't see me changing first line treatment without more data, or a patient with huge worries about steroids as a therapy. Even then, don't know if this has convinced me to go with Tac alone. Maybe I need a trip to West London. #NephJC

When would you go for Tac? De novo disease? Relapse? Or are you not convinced by this study? #NephJC

@NephJC And when you discuss the evidence with your patient and consider their opinion too #NephJC

@HotKidneyAction @NephJC Read correctly. I think you're right; it prob contributed. We were trying to compare the two regimens, not identical treatment durations. Interesting that even a long (ish) course of treatment with Tac was well tolerated #NephJC

@NephJC If I've read this right, Tac group remained on more immunosuppression for longer after remission was achieved (pred was tapered) - does this explain the time to relapse rather than difference in efficacy? #NephJC

What about relapse rates? At 26 weeks from CR, 57% in Pred cohort and 68% in Tac cohort were relapse free (p = 0.54; ∆ 11% within 95% CI of -16 to 42%). Median time from CR to relapse was 22 wks for Pred cohort and 32.7 wks for Tac cohort (p = 0.72) #NephJC

What to do with the relapses. Rechallenge with Tac? #nephjc

@carlo_alfieri @NephJC Doses were similar but because multicentre, indvidual agents and doses used varied and statistical comparison difficult. We didn't insist on maximal RAASI. Clinically, we don't max RAASI before starting pred or tac in MCD #NephJC

@NephJC Apart the quantity of patients it can be more useful evaluate if the dosage of RAASi were similar #NephJC

Mean age ~ 40 years. Note 40% of patients were on RAAS inhibitors (ACEi/ARB) #NephJC

@HotKidneyAction @sarah_gleeson_ @NephJC @goKDIGO 'If' you move away #NephJC

@sarah_gleeson_ @NephJC @goKDIGO Are you going to revert to steroids when you move away? #NephJC

@goKDIGO guidelines recommend steroid as first line in MCD. When have you considered alternatives as first line?#NephJC

@HotKidneyAction @sarah_gleeson_ @NephJC @goKDIGO You might have DM @sarah_gleeson_ to get an honest answer😉 #NephJC

Patients themselves often ask if there's an alternative an alternative to steroids. #NephJC

#NephJC. Nick Medjeral-Thomas. MinTac author. No other COI

MinTac Trial: Tacrolimus monotherapy can be an effective alternative treatment for patients wishing to avoid steroid therapy for minimal change disease ca. 2020 from @CJASN @NickRhysMT @megan_griffith1 @IgAN_JBarratt @neilturn @Profcpusey #Nephpearls 👉🏼 cjasn.asnjournals.org/content/early/…

@ThePeanutKidney @aishaikh @Ashidotic @renalpathdoc @SethiRenalPath @toates_19 Yes, can detect by IP, but sensitivity meant to be better with IF. The extra step is the pronase antigen detection, but if done correctly, IP and IF should work. You can always refer slides to Terry Cook who does this routinely on most C3G pts, esp those over 50yrs age

@aishaikh If only 😥. We only use immunoperoxidase at our centre (so presumably already on paraffin sections). Is detection of masked deposits feasible with IP? @Ashidotic @NickRhysMT @renalpathdoc @SethiRenalPath @toates_19

💥In an adult patient with C3GN pattern with no Ig deposits ALWAYS do IF on pronase-digested paraffin tissue as you may miss a Monoclonal Protein mediated MPGN. In this case, pt. was diagnosed with PGNMID due to monoclonal IgG/kappa👇🏽 #KidneyWk Dr. C. Nast

Tacrolimus works as well as steroids for adult minimal change disease, from @NickRhysMT & @megan_griffith1 Day 1 #KidneyWk highlights

Glomerular complement deposition, in particular FHR5. Next 😉

#KidneyWk #MinimalChange groundbreaking study showing it is possible to avoid steroids in patients with minimal change

Grilling them? Ha, nah, more like praising them. Important work from @megan_griffith1 and @NickRhysMT providing an efficacious alternative to high dose steroids for minimal change podocytopathy. @LGlomcon #KidneyWk