MTP：Meet the Professor (1-2

MTP-1 AUTOIMMUNITY AND THYROID CARCINOMA

ROSSELLA ELISEI

Associate Professor of Endocrinology, University of Pisa

Thyroglobulin (Tg) is a protein produced and secreted only by thyroid cells. Its production is maintained also by tumoral cells in well differentiated thyroid cancer (DTC) such as papillary (PTC) and follicular (FTC) hystotype. Since many years, it has been recognized as the most sensitive and specific marker of residual thyroid tissue and/or persistence/recurrence of the disease in patients affected with DTC and treated with total thyroidectomy (TTx) and post-operative remnant ablation (RRA) with radioiodine (131I).

However, approximately 25-30% of patients with DTC have serum thyroglobulin antibodies (TgAb) which interfere with Tg measurement, causing either false negative (by immunometric assays) or false positive results (by radioimmunological assays). TgAb are the expression of an associated lymphocytic thyroiditis (LT) or the expression of an immune reaction to DTC. In these cases, serum Tg loses its function as tumor marker, but the change of the serum TgAb levels over the time can be used as a “Tg surrogate” since it has been demonstrated that in cured DTC patients, the TgAb levels decline to reach the negativization. At the same time, the persistence of stable levels of TgAb for a long period of time or the increase of TgAb levels after TTx plus/minus RRA represent an alert about the possibility of persistence or recurrence of DTC. Currently, this concept is so well established that the new international referral guidelines for the management of DTC include the TgAb evaluation after initial treatment as essential to assess the ongoing risk stratification.

MTP-2 CLINICAL MANAGEMENT OF TYPE 2 DIABETES WITH CHRONIC KIDNEY DISEASE IN JAPAN: CURRENT SITUATION AND STRATEGY

ABE MASANORI

Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan

Type 2 diabetes mellitus is among the leading causes of end-stage kidney disease (ESKD) worldwide. However, in Japan, the percentage of patients who had initiated dialysis because of diabetic nephropathy has not increased in recent years. A probable reason for this is that angiotensin II receptor blockers, ARBs, came into general use in Japan from 2000 onwards, and we can also use DPP-4 inhibitors. Furthermore, the sodium-glucose cotransporter 2 (SGLT2) inhibitors provided kidney protection. Therefore, we can easily treat diabetes even in patients with chronic kidney disease (CKD). But, in Japan, there’s a prominent primary cause of CKD. It is hypertensive nephrosclerosis. Nephrosclerosis is caused by long-term hypertension. Japan has the highest aging population ratio, and consequently, nephrosclerosis continues to increase in Japan. So, to prevent ESKD, diabetic nephropathy, which is the most common primary disease, and ever increasing nephrosclerosis are the important diseases to target for Japan.

Here, we will describe the cardio-renal connection, and show the different trajectories between diabetic nephropathy and nephrosclerosis. Finally, we will describe the kidney protection by SGLT-2 inhibitors for diabetic kidney disease.