It's me. Hi. I'm the problem, it's me. open.substack.com/pub/pulmccm/... @thinkingcc.bsky.social @khaycock.bsky.social @drfreeze.bsky.social @maxhockstein.bsky.social @www.pulmccm.org

Trying to catch up with IgA Nephropathy trials⁉️ Check out ✅ “IgAN: An Overview of the Clinical Trials” ca. 2025 from @kidneymed.bsky.social @alexgr23.bsky.social @saynanorouzi.bsky.social #Nephpearls #NephSky #KidneyWk #IgAN 👉 pubmed.ncbi.nlm.nih.gov/41050133/

Forgot to post the two at plenary on Thursday FINEONE: finerenone in T1DM ORIGIN: Atacicept (pronounced attack-e-sept) in IgAN (pronounced eye-gee-A-N) Possible NEJM or Lancet simulpubs? #KidneyWk

watch out - ORIGIN-3 and FINEONE likely simultaneous publications tomorrow morning! #KidneyWk

Renal tubular epithelial cell cast (Sternheimer-Malbin stain) under 1000x bright field. Pt with nephrotic range proteinuria, suspected GN. Note small lipid droplets on most inferior cell in the cast.

Tried to clean and organize my library today…

In a CKD pt, the fear of giving iv contrast during a CT (to diagnose cancer) is more than the fear of cancer. I need radiologists/techs to understand that A. If I’ve signed the form, I know what I’m doing! B. The risk of “contrast nephrotoxicity” is negligible, perhaps non-existent. Read the lit!

RIP to the “Father of ECMO”, Prof Bartlett. elso.org/ecmo-resourc...

I kinda feel like I’d missing out on a lot by not attending Kidney Week 2025, but I really, really don’t want to go to the US anytime soon.

🌿 Herbal medicine: tradition… but also risk. Some plants are nephrotoxic and can injure the kidneys. 📖 In Tropical Nephrology 2025, we review mechanisms of kidney injury linked to medicinal plants. 🔗 link.springer.com/chapter/10.1... #Nephrology #TropicalMedicine #KidneyHealth

“When you die, it is either the end of everything – you are gone, snuffed out, finished, or there is something. I happen to believe there is something – so I can’t think of a more exciting adventure than finding out what the something is.” - Jane Goodall www.ft.com/content/9600...

Stayed home today and decided to do some art.

There are protests against corruption going on all over our country today. I cannot go (long story), but I stand in solidarity with them.

#Nephrology faces a shrinking workforce & burnout crisis, but also a chance to transform. #StanDOM's Glenn Chertow highlights the opportunity. bit.ly/479LPBT

🫘

So excited for this, @glombandit.bsky.social !

"Patients with severe HTN without evidence of acute target organ damage (previously called hypertensive urgency) should NOT have aggressive BP lowering in the short-term or be given parenteral anti-HTN drug therapy." (my caps) New 2025 AHA HTN guidelines! share.google/2Xc7UFRimn2A...

It’s been a while. And I wanted to try something new. #kidneyart #nephsky

Some clinic days just suck the life out of me.

Lost my mojo for a while. This one’s not finished yet, but I just felt like posting. #kidneyart #nephrology #artsky

Based on the image provided, what would be your leading diagnosis with C3-dominant immune-complex deposition? #DiagnoseThis #pathology #renal #kidneypath #pathx #pathsky

Patient’s potassium result was too low Fired the lab manager

#Quiz from January 2022: A 57-year-old woman presented with severe hypokalemia; the electrocardiogram showed sinus arrhythmia, flattened T waves, and prolonged QT interval of 667ms. How should this patient be treated? bit.ly/3pFr8au (FREE)

Renal fellow caught vacuolar casts in a patient with PV, RPGN, CHONuria of 13g/d. #urinoscopy #urinesediments #nephrology

Get. Vaccinated. "Among patients hospitalized with COVID and acute kidney injury (AKI), unvaccinated individuals had longer hospital stays, more frequent need for continuous renal replacement therapy, higher dependence on dialysis at discharge, and substantially... www.medscape.com/viewarticle/...

Breaking news: “The Late Show” with Stephen Colbert will end in May 2026, CBS said in a statement. The announcement came days after Colbert spoke out against the $16 million paid earlier this month by Paramount, the parent company of CBS News.

Elderly px with NSTEMI, +worsening azotemia and oliguria. Resident to AP: Refer #Nephrology? AP: Not yet. Hosp D6: +asterexis, dec sensorium. AP: Refer to Neurology Hosp D7: Neuro rpts labs. BUN 92, crea 10.4 Neuro Dx: Uremic Enceph Neuro Plans: Refer to Nephrology. 🤯

Intraop px has 1L bld loss and hypotension. Immediately given several doses of NSAIDs x 3 days. Crea inc fr 1.3 to 4.2. No #nephrology referral done. They rpt crea the next day. Now 6.4. They FINALLY call me. Px gets mad b/c of extra cost & delayed discharge. #Ortho then blames nephrologist. 🤯

Mangroves store 4–5 times more carbon than land forests, making their conservation and restoration important for sustainable development, biodiversity, and climate. However, half of the remaining mangroves are threatened. #WetTribe #TidetotheOcean #MangroveMonday

What an honor to participate in this podcast and discuss my hero, Burton Rose, medicine’s most important educator pca.st/episode/eeb0...

Watching #Superman was like watching Ted Lasso: made me feel all joyful and hopeful and inspired. Thank you, James Gunn! CTTO

Just saw Superman. Was gonna do a whole bit about it walking in. That’d be a disservice. It’s an important piece of work and I’m not joking. I don’t even like superhero movies. Sprint to see it. Bring your kids and explain it to them. James Gunn had a time machine when he made it.

effect of BP drugs on rapid decline in GFR on CKD 🔗 academic.oup.com/ajh/article/... 🔓 #EditorsChoice #OpenAccess

Only reason to sequence the RASi first is that they are good antihypertensives (but note the BP effect in the combo arm of #confidence) #nephjc But no matter the sequence, the goal should be to have someone on the four pillars in less than 6 months

T3m #NephJC But here’s the flip side ✅internal validity was strong ✅nearly all participants (98.4%) were on maximally tolerated ACEi/ARB ✅high Asian representation (46%) - important given Asia’s large population and unique risk profile for diabetes-related complications❗️

Been giving RASi+SGLT2i+Finerenone to my DKD pxs and I can attest to this.

Maia from the Philippines, joining in between rounds!

Following on CONFIDENCE (on #NephJC tomorrow) The design and baseline data from MIRO-CKD trial academic.oup.com/ndt/advance-... N = 614, balcinerone, dapagliflozin Urine ACR outcome #NephSky

🎨Check out the beautiful #visualabstract by #NephJC intern @shelliefravel.bsky.social ⏰Chat happening on July 8, 9 pm EST www.nephjc.com/news/2025/7/...

Effectiveness of VExUS scores for predicting mortality among patients followed up in the emergency department due to congestive heart failure: a prospective cross-sectional study #VEXUS #POCUS #Echofirst bmcemergmed.biomedcentral.com/articles/10....

Systemic Inflammation and the Risks of Adverse Kidney Outcomes in Adults With Atherosclerotic Cardiovascular Disease bit.ly/Mazhar25OI #OpenAccess #VisualAbstract

#RenalPath: Diffuse granular capillary wall staining for phospholipase A2 receptor (PLA2R). PLA2R staining is positive in approximately 70% of patients with clinically idiopathic membranous nephropathy (immunofluorescence microscopy, PLA2R). bit.ly/2xVkJzs (FREE)

Why are the bad guys winning?

Tirzepatide and semaglutide are both highly effective for the management of obesity. How the two drugs compare in patients with obesity but without diabetes has been unknown. Research findings from the SURMOUNT-5 phase 3b trial are summarized in a short video. nej.md/3GqiRm0 #MedSky

Why are some nephrologists still afraid of IV contrast????

Nephrotic syndrome is associated with excessive thrombin generation and impaired fibrinolysis, increasing risk of thrombosis. kidney.pub/KID0865 #ASNKidney360

We don’t get to discuss every important study that comes out on #NephJC Hence #NephJCShorts www.nephjc.com/news/nephjc-...

I don’t normally flex gifts given to me but this one deserves a post. ♥️

T0d: #NephJC CKD’s story is shifting- RASi, flozins, MRAs, and GLP-1s have redrawn the map, turning a therapeutic desert into a landscape of cardio-renal possibility Relevant infographic from @brendonneuen.bsky.social‬ academic.oup.com/ndt...#NephJC