What type of fish oil commercially available in the US most closely approximates the PISCES study formulation? Not an expert but I think not every fish oil being sold is equivalent. #askrenal #nephjc #nephsky

And why did finerenone get away with it? Kerendia is being prescribed right and left now because they had the RCT data and FDA approval. But it’s very clear to me that old MRAs r just as protective, just lacked the RCT data for non medical circumstances. An unpopular opinion, but I own it.

NSAIDs leading to extinction of vital species in India www.nature.com/articles/d44...

My initial thoughts about aldosterone synthase inhibitors: why spend $$$$ to achieve what $4 of spironolactone can also achieve? Am I missing something? #askrenal

IgA is pronounced eye-gee-ay The reason the disease should be called "eye-gee-ay nephropathy" is because IgA is central to the pathogenic mechanism. Moving to eye-gan is moving away from describing the disease by its pathogenic mechanism.

Is calling “I-G-A nephropathy” “Eye-GAN” mainstream now? I am really struggling to accept that. #askrenal

‘Booty’ and ‘butt’ are synonyms. ‘Call’ and ‘dial’ are synonyms. But, a ‘booty call’ and a ‘butt dial’ are VERY different things.

Mother: I have twins. Doctor: Oh, so they were born on the same day? Mother: No, they were born with the same propensity score.

Funny highlight of today’s road trip

Time to make a polypill for CKD? Telmisartan+ #flozin + finerinone + statin+ oral semaglutide? Call it Tel-em-fine-at-tide Telemfinatide? At least for countries with affordable pharma price negotiations.

Lately, I don’t enjoy @nkf-professionals.bsky.social or @asnkidney.bsky.social meetings as much as @renalphysicians.bsky.social First 2 are about “cool drugs that cost a million and improve 1% of patients by 30%” rather than “How to survive & thrive as a burnt out specialty no one wants to join”

Funny that tool looks familiar… downloaded from the RPA store

“If you have abdominal pain on the right, upper or lower, around belly button or lower, severe, throbbing, in one spot or moving around, go to the ER (not PCP or urgent care)”- HuffPost Next article coming soon: “Crisis: How ER visits drive up healthcare costs” www.huffpost.com/entry/stomac...

“officials regularly ignore the rankings, leapfrogging over hundreds or even thousands of people when they give out kidneys, livers, lungs and hearts. These organs often go to recipients who are not as sick, have not been waiting nearly as long…” www.nytimes.com/interactive/...

Adult nephrologists, with your hospital administration and state malpractice environment, would you feel comfortable dialyzing a kid coming in with toxic ingestion if asked to? Why/ why not? #askrenal

Once upon a time, some villagers came across a large, ornate wooden box in the local woods. On the side of the box was a message: “Whatever money you put in this box will, in future, grow to become 2.5 times larger.” 1/

Interesting thread by James Heather about the indirect rate caps by the #NIH . It is not the first time this comes up e.g. both the Obama and the 1st DJT admin tried to cap them (with fierce discussions on Twitter back in 2017).

US nephrologists, while discussing incoming fellow quality with regional faculty, most seem to be disappointed (big picture, everyone has many bright spots). New meds but worries about doc quality. How do you see the future of nephrology in 10 years? Stable/ascendant/declining?Why? #askrenal#nephsky

Things used in nephrology without evidence or despite evidence of futility: Urine eosinophils Urine anion gap Albumin correction for anion gap and calcium Slow correction for mild-moderate hyponatremia Vitamin D for renal bone disease Anything else to add to list? #askrenal

“Even mildly elevated serum phosphate levels of >3.5 or >4.0 mg/dL should receive attention” What do we mean by attention? Identify phos as risk factor when stratifying-maybe. But pretty please don’t let it mean use phos binders to lower phos below 4 in ADPKD

Nephrologists/physicians, what licenses do you need to keep working and what dues do you pay to remain a member? Lets document costs.For me: State license:$360 DEA: $888 Special CME for dea/ state: $550 ABIM: $340 ASN: $475 RPA: $435 1 meeting/ year: $2000 AMA: free (institution) #askrenal #medsky

My extortion notice with the associated gangster threat has arrived.

US nephrologists, how are you posting urine sediment pics given CLIA law requiring special microscope handling/regulatory training and retraining? A- What? I wasn’t aware B- I use my lab’s stuff and document regular re-training C- Keep department microscope with CLIA compliant records #askrenal

Happy to share our paper in @asnpublications.bsky.social examining COL4A5 X-linked Alport Syndrome in an unselected health system-based population. Phenotypic spectrum of X-linked Alport syndrome is wider than previously known. Risk lower for Gly624Asp variant. 1/ journals.lww.com/jasn/fulltex...

Controversial take: the social worker role in dialysis should be completely revamped. Stop wasting their time on worthless KDQOL data collection and certify them in psychotherapy and CBT instead so dialysis patients have weekly access to therapy sessions. #Nephsky jamanetwork.com/journals/jam...

Suggested 2025 nephrology research resolution: any institution/ investigator asking for new funding for another Vitamin D trial in nephrology should be personally responsible to return the waste of funding dollars if the trial results are similar to the past 149 trials. #StopResearchFundWaste

Everything cool until the end ‘…we need further high-quality vitamin D trials which focus on clinically meaningful outcomes including fractures, BMD, as well as cardiovascular and kidney endpoints.’ Nope. We need a moratorium on vitamin D trials @maximalchange.bsky.social #NephSky

Paraphrasing another candid trainee reason for not choosing nephrology🧵(1/3) “You guys never seem to do anything for the majority of your inpatient consults. Cardio stents/stress tests, hem/onc blasts with fancy genetically determined meds, rheum uses cool meds all the time. GI scopes most of them…

Anyone got a gold standard way to wean advanced CKD patients off baclofen? A lot of nephrologists are just asking people to stop taking it and withdrawal can be life threatening (saw 2 cases and don’t want to see any more) #askrenal

Urgent start PD is a logistical nightmare in most of the US. Lack of nurses, surgeons refusing to take sick people to OR but ok for HD catheter, poor expertise to manage complications, few outpatient trainers when needed. Not sure a reduced risk of peri-catheter bleed will overcome all that.