excellent review of complement based therapies in ...IgA Nephropathy in @ajkd.bsky.social from @sstoneman.bsky.social et al www.ajkd.org/article/S027... Fig 1 with the 4-hit theory 1/

3/n although the lobulated nuclei made it clear that the cells were leukocytes, we still confirmed it with Prescott-Brodie stain

1/n young adult gets transferred to our hospital for higher level of care. Had presented to a rural institution with weakness; found to have Hgb 7.5, serum Cr 2.6 mg/dL, hematuria. Prompted a positive p-ANCA. Nephrology is consulted on arrival

We really don’t think BigPAK makes sense From our journal club at @uottawa.ca into a #NephJC shorts www.nephjc.com/news/2025/12...

7. Personal level. Beyond his talent and expertise, I met an extraordinary man. Humble, altruistic, wise, friendly, and with a great sense of humor. I brought him a vacuolar cast tie as a present and he wore it proudly right away 🤩

1/n Recently attended an international congress about Urinalysis in Santiago, Chile 🇨🇱. I was expecting a small meeting. I was wrong. Pleasantly surprised with the size of the meeting and the energy and interest from the participants. Let me share the highlights of my experience:

A study that could only happen in the US jamanetwork.com/journals/jam... in @jamanetworkopen.com Offering outpatient dialysis to uninsured peeps with kidney failure might help save $$ by reducing LoS #NephSky

Dual-Antigen Membranous Nephropathy doi.org/10.1016/j.kint.2025.10.006 #NephSky #MedSky #membranousnephropathy @mayoclinicpath.bsky.social @arkanalabs.bsky.social @lynncornell.bsky.social @aaronstorey.bsky.social

🔬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/...

The urine in glomerulonephritis really glows ✨ #urinarySediment

Thanks @amyaimei.bsky.social for giving an excuse to share some #UrinarySediment pics. See below for context 👇🏼

Not hugely practice-changing, as many folks are already using bicarb to reduce dialysis risk based on BICAR-ICU-1 Lack of mortality impact is unsurprising given how difficult it is to prove in ICU (discussed: emcrit.org/pulmcrit/mor...) Reduced dialysis & bacteremia are important pt-centered wins

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.

This is great! Renal biopsy by the nephrologists!

Interesting case from the Skeleton Key Group which just keeps pumping out the #FOAMed www.renalfellow.org/2025/09/28/s...

Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀 Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc) If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC

Mixed cellular containing RBCs, WBCs (blue) and RTECs (fuchsia) in the #UrinarySediment from a patient with suspected IgA nephropathy 🔬bright field (500x) and oblique illumination (1000x) #UrineMicroscopy #OchsnerNephrology

I was just reminded that I once made an autoportrait of my distal LAD flow in 3D (and got it published!) #echosky #cardiosky pubmed.ncbi.nlm.nih.gov/29993929/

Following #KidneyWk I’ll be flying to Santiago, Chile, for a #UrinarySediment Microscopy conference 🔬 citem.cl/congreso-int...

Key point from my invasive CO talk the other day #CHEST2025

A famous nephrologist getting ready to go see the most famous guy who plays a nephrologist @glaucomflecken.bsky.social @stanforddeptmed.bsky.social Grand Rounds!

We are thrilled to announce that we have generously received funding for a one-year hypertension fellowship, and we are recruiting now for a candidate to start fellowship July 1, 2026 . med.stanford.edu/hypertension/e… -Jehan Zahid Bahrainwala HTN Fellowship Program Director

Go to Stanford and learn from the best for hypertension! #NephSky

Secondly, loop diuretics act as venodilators, which means if you look at vena cava shortly after a diuretic dose, vena cava (and RAP/CVP for that matter) may suggest normovolemia even if the patient is still volume overloaded. www.ahajournals.org/doi/10.1161/...

First of all, I think it’s well overdue that we abandon the use of vena cava size (or at least downgrade it). It’s the poorest parameter! Vena cava circularity/sphericity is much better! pubmed.ncbi.nlm.nih.gov/28065586/

Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky

☝️DIGIT trial shows benefit from digitoxin in HFrEF (even in context of reasonable GDMT) numerous limitations but consistent w/ the seminal DIG trial (👇 hospitalizations) digitoxin is hepatically metabolized making dosing easier (not available in USA) #1/2 #EMIMCC www.medscape.com/viewarticle/...

for those of you worried about the safety of PPIs among critically ill patients: this RCT evaluated the effect of using insanely ridiculously ginormous mega-doses of esomeprazole in septic patients and... ...absolutely nothing happened. #EMIMCC journals.lww.com/ccmjournal/f...

Case in point: vasopressin is probably only a wise choice if EF is supranormal pubmed.ncbi.nlm.nih.gov/37030157/

Extremely striking difference in utilisation of Impella in the US vs UK and Canada. #cardiosky #cccsky #emimcc jamanetwork.com/journals/jam...

P-values are fraught with hazard, but SO IS BAYESIAN STATISTICS the Achilles heel of Bayesian stats is that someone determines a pre-test probability distribution (usually arbitrarily) The pre-test probability is often too high This inflates the final posterior probability 🧵 #1/4 #EMIMCC

assessing the severity of methemoglobinemia: people get too hung up on % methemoglobin *functional hemoglobin level* is more important 30% MeHb is OK if total hemoglobin is 15 mg/dL, but a big problem if total hemoglobin is 7 mg/dL same idea as O2 saturation vs. O2 carrying capacity 👇 #EMIMCC

technically this is true “up to 40%” my bank account contains “up to 10 billion dollars” the words “up to” are doing a lotta work here 😆

Myth busting: Antibiotics don't reduce mortality in variceal hemorrhage! I updated the IBCC & explained what happened here emcrit.org/ibcc/gib/#va... We probably don't need antibiotics at all🤦‍♂️ Nice illustration of how meta-analyses can be fragile (even Cochrane) emcrit.org/pulmcrit/meta/ #EMIMCC

Convoluted RBC cast; case of endocarditis-associated crescentic necrotizing glomerulonephritis #UrinarySediment #UrineMicroscopy #PisseProphet #OchsnerNephrology #Glomerular #GN #AKI

I will never get over how creepy it is how the NIH X account is a full time propaganda machine now

The Maltese Cross 🇲🇹🛡️sign is not unique to lipids, other structures can manifest it under polarized light (eg, starch, leucine crystals). Here, a rare sighting of a cast containing suspected ciprofloxacin crystals. #UrinarySediment #UrineMicroscopy #PisseProphet

We use aminoglycosides widely, and gentamicin specifically, in Norway. Only case of clear ototoxicity I’ve encountered was in an endocarditis case with overdose over many days (after weeks of therapy, medical error).

we're under-utilizing aminoglycosides for urosepsis in patients with good renal function rising % ESBL is pushing us to use carbapenems for empiric therapy... leading to more resistance (CDiff, CRE) aminoglycosides have minimal gut penetration = low CDiff risk & protect microbiome 🧵 #1/4 #EMIMCC

I made some improvements to my Stewart acid-base calculator, I think some of you might find it useful as well: medischesnippers.nl/stewart/ Let me know if you find any bugs or errors. @pulmcrit.bsky.social @kidneyboy.bsky.social

8/10 #NephJC Quote of the fortnight @hswapnil.medsky.social‬ and @christosargyrop.bsky.social ‬ quickly agreed on new treatment goals for DKD #ZeroAlbuminuria

Guidelines no longer recommend holding typical first-line antihypertensive meds since renin will most often still be suppressed despite being on them in true PA. Growing evidence supports proceeding with screening Hot off the press from the Endo Society: www.endocrine.org/clinical-pra...

What is at the top of your differential in a patient with a positive SPEP (IgG kappa) and the immunofluorescence finding below? (hint: lambda is negative) #DiagnoseThis #pathology #renal #kidneypath

this would be lovely in the ICU, to avoid excess sedation. when we have patients on propofol sedation who happen to be on EEG monitoring, I’m often shocked by how completely flat the EEG is. (it’s not normal or beneficial to have a totally flat EEG - makes it harder to wake up 😩) #EMIMCC

amiloride - allows large volume diuresis without needing to give the patient potassium every 5 minutes and without risking the potassium going to zero if nobody is paying attention seriously I'm pretty sure it improves safety (less hypoK) and saves money (less IV potassium infusions)

Interesting that when Renal Guard was double blinded (sham controlled) it stopped working 🤔 pubmed.ncbi.nlm.nih.gov/31120108/

Great article on dogma in ID (with parallels to critical care) We have HUGE problems re: guidelines making recommendations & *redefining* entire diseases based on minimal data. Gov't metrics exacerbate this further. @bradspellberg.bsky.social @absteward.bsky.social @drtoddlee.bsky.social #EMIMCC

Nice commentary explaining this in the setting of inaccuracy of TR gradient for estimating SPAP, but the same applies to aortic stenosis of course. journal.chestnet.org/article/S001...

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%! Practice changing investigator-initiated RCT. #ISTH2025

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