We had a lot of discussion with Barratt at his rounds on this. His point is that - early diagnosis/identification early in disease process will be key - we do have specific treatment options available now (or will soon have) - just RASi and Flozins without biopsy just masks the issue #NephJC

🎨Beautiful visual abstract by Dr Natalia Nombera @roxnonna23.bsky.social #NephJC www.nephjc.com/news/...

Hey everyone, Marc from the Philippines. Looking forward to learning tonight. No COI #NephJC

🔬for the diagnosis of glowmrulonephritis, searching for urinary acanthocytes only using bright field illumination is clearly suboptimal compared to utilizing dark field illumination or phase contrast microscopy. #UrinarySediment #UrineMicroscopy karger.com/gdz/article/...

⏩ Next #NephJC is on IgA nephropathy @kdigo.org guideline 🎨 Nice visual summary by @roxnonna23.bsky.social www.nephjc.com/news/2025/10...

Obinituzumab aka ‘Obi’ is now FDA approved for lupus nephritis finance.yahoo.com/news/fda-app... #lupus

No one should I remember being mobbed by dietitians in Argentina who are believers in this costly approach (after #ISNWCN debate) Outdated therapy. Move on and flozinate instead #NephJC

Here’s @kidneyboy.bsky.social take on that study pbfluids.com/2009/02/jour... #NephJC

🎨Beautiful visual abstract by @msocomd.bsky.social #NephJC

Check the insightful #NephJC summary by @shelliefravel.bsky.social

Hi everyone, Marc here. Looking forward to hearing everyone’s insights. No COI. #NephJC

Check at the VA for our discussion of protein diet strategies by @msocomd.bsky.social. Is restricting protein in CKD and pushing protein in ESRD #TWDFNR? www.nephjc.com/news/2025/10...

It's that time of year again 🍂🍂🍂 The #NephJC Fall pledge drive. Plese give if you are able to support our decades long mission of #FOAMed for all. #NephSky #MedSky www.nephjc.com/news/2025/9/22/nephjc-fall-pledge-drive

1/10 Welcome to #TenPostNephJC Last #NephJC we discussed about AHA/ACC 2025 Hypertension guidelines: PREVENT, Detect, Treat Didn’t catch the pulse of this one? No worries we’ll help you pressure check the 2025 AHA Hypertension Guidelines. ❤ #AHA2025 www.ahajournals.org/doi/10.1161/...

Right: more aldo, more combo meds, advocating for GLP1 as part of lifestyle change Wrong: 130=/=120, even stronger aldo rec, even stronger GLP1 rec so that insurance will cover it #nephjc

www.nejm.org/doi/full/10.... There’s some trial data on prevention of albuminuria #nephjc

Yes! Slide care of Paul Whelton at this year’s #Hypertension25 #nephjc

Even when we say we will use MRAs earlier, we don’t! We showed this. Screening is associated with WAY more MRA use (probably in part because those who think to screen are more likely to treat based on best evidence) pmc.ncbi.nlm.nih.gov/articles/PMC... #nephjc

But each has benefits like a fine wine: -The uric acid lowering of losartan -The longest half life of telmisartan -The bonus migraine prophylaxis of candesartan #nephjc

T1h Next up – Secondary HTN. The guideline provides a thorough table including 15 causes of secondary HTN with indications for additional testing and diagnostic screening tests for each. #NephJC

Check the insightful #NephJC summary by @msocomd.bsky.social and @salinesolut.bsky.social They’ve distilled a large, voluminous document into an insightful, well-written, and easily comprehensible resource.📌 You may want to bookmark this as a ready reckoner

Hey everyone, Marc here from the Philippines, currently joining in from Prague. No COI, but I have huge respect for our European colleagues who are usually with us at this wee hour—true dedication! #NephJC

❤️Check out the VA for the discussion on the AHA/ACC Hypertension Guidelines 9/16/25 at 9pm EST by @sejalplakhani.bsky.social #NephJC #NephSky #MedSky www.nephjc.com/news/2025/9/ahaacc-htnguide

Change is in the Autumn air 🌬️🍂 Join use only on #Bluesky on 9/16/25 at 9pm EST. We're discussing the 2025 ACC/AHA Hypertension Guideline Update. 🫀🫘🧠 #NephSky #MedSky www.nephjc.com/news/accaha2025-klno3

Check out the latest @kireports.bsky.social community blog from @husamjz.bsky.social Anticoagulantion in ESRD patients with atrial fibrillation: www.kireportscommunity.org/post/bleeding-clotting-and-kidney-disease-in-atrial-fibrillation-can-factor-xi-inhibitors-change-the-g

Finally, the concurrent results of the ALCHEMIST trial (www.sciencedirect.co...) also showed that spironolactone did not reduce major cardiovascular events in older, high-risk hemodialysis patients. #NephJC Infographic by @nephroseeker.medsky.socia

@nephjc.bsky.social @lastwalsh.bsky.social just presented ACHIEVE results at #ANZSN. Here’s a some details of country differences not in the main paper

And ALCHEMIST had way lower hyperkalemia (they used a lot of K binders, about 45% at baseline!) - see @nephroseeker.medsky.social VA Despite that there was no benefit! www.nephjc.com/news/2025/ne... #NephJC

The assumption was about CV risk: if DM then they are at high risk, otherwise age + ESRD = high CV risk #NephJC

Hi everyone! I’m Marc, checking in from the Philippines. Looking forward to another great discussion with you all #NephJC

⏰2 hours until #NephJC chat Preventive Nephrology in the dialysis population? Join us today, 9PM EST in NephJC chats to discuss the Aldosterone Blockade for Health Improvement Evaluation in End-stage Renal Disease (ACHIEVE trial) www.thelancet.com/jo...#NephJC

And even when Green opens the door to make it about rich countries, and discuss the possibility of MDR Tb getting out control and becoming an uncurable super drug, he backs away and makes it clear we should treat TB not because of some perverted self interest but because it is right. #NephJC

Did you like the cast of famous people with TB? Who surprised you? The mother and son pair of Eliza Poe and Edgar Allan Poe was surprisiong to me #NephJC

Hello, I’m Marc, a nephrologist from the Philippines. Sorry i’m a bit late. I came across a signed copy while traveling in Rome. TB remains highly prevalent in the Philippines, and we still encounter it frequently in clinical practice. This was a really good read. #NephJC

Sometimes more lessons are learned from failures than successes. I've learned quite a bit from working through the challenges of this trial. #NephJC

Up next! ☀️📚 We're taking a short break from trials, but don’t go far— #NephJC Summer Book Club is back! We’ll be diving into “Everything is Tuberculosis”—a powerful, thought-provoking read. Join the conversation soon! 📖

Until now, phosphate has been a villain by reputation, not by trial evidence. The unsettling part is that so much of our practice has been built on consensus rather than solid data #NephJC

I would also add that the separation of 0.8 mg/dl is inflated by the baseline difference in phosphate (i.e., not all the result of the intervention). Also, the outcomes of all-cause mortality & hospitalization have substantial "noise." #NephJC

HiLo2 brought to you by Coca Cola -free Coke for hi -free Sprite for lo #nephjc #newnewnephrology

Correct. Electronic consent with educational materials and videos was mostly successful. The lack of dedicated coordinators- especially on-site coordinators- really left us vulnerable to events such as the pandemic and workforce turnover. #NephJC

Important to highlight the timing here. Enrollment was held for much of 2020 when the pandemic hit. The equally large (and lingering) challenge was the burden placed on the dialysis staff in the wake of the pandemic. This affects all aspects of trial without research staff. #NephJC

T2d Primary outcome 🎯 After 1.4 years median follow-up: ☠️ Deaths: 16% (Hi) vs 21% (Lo) 🏥 Hospitalizations: 720 (Hi) vs 685 (Lo) 📊 Win ratio: 0.97 Surprised by this ❓#NephJC

Why wouldn’t folks want to sign up for more diet liberalization/less phos binder requirement? Is it bc that’s a patient centered outcome v a doctor controlled metric? #nephjc

Not a fun for cluster trials for this question either. Massive loss of power due to noise (=large between facility variation) especially for mortality and admission outcomes. Expect me to say this more than once tonight #nephjc

#NephJC I’ve got Hi hopes (and Lo expectations)

T0i Here’s the twist 🌪️ What if patients prescribed strict phosphate control are actually exposed to risks we haven’t fully recognized… because they’ve never been tested in a robust RCT? 😬#NephJC Take a look at this visual: www.ajkd.org/article...#NephJC

Hey everyone! I'm Marc, a nephrologist based in Cebu, Philippines. Looking forward to join the discussion. No COI. #NephJC

😎Check out the VA for HiLO by @sejalplakhani.bsky.social 🆒 This should be quite the discussion, don't miss it! #NephJC #NephSky www.nephjc.com/news/2025/8/4/the-hilo-trial-visual-abstract

🎙️Hosting this chat was a step outside my comfort zone—but we grow as we go, and it’s been a joy Grateful you joined us, whatever timezone 🌏 #NephJC found you Always a privilege to learn from and with this amazing community ❗️ That’s a wrap from me– this has been Marc (@msocomd.bsky.social)