1/10 Last #NephJC we discussed Pegcetacoplan in C3 Glomerulopathy and Immune-Complex MPGN #TenPostNephJC Given the central role of complement dysregulation in C3 glomerulonephritis, we assessed whether complement-targeted therapies confer therapeutic benefit. www.nejm.org/doi/full/10....

🎨Beautiful visual abstract by Dr Akshaya Akshaya Jayachandran #NephJC

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 🤩

6. Prof. Fogazzi. Definitely a big highlight for me was to meet for the 1st time Dr Giovanni Fogazzi, an icon in the field. Still remember when I bought his book early in my career. One my fave pics is this one that captured a moment when he stood up to ask a ? after my talk. Very cool. #BigFan

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:

Day 1, #kidneywk 25, We attended the poster presentation, which focused on an important topic: Reducing gaps and strengthening training in urinary sediment analysis. We were joined by someone passionate about U-sed. @juancarlosqvelez.bsky.social , @roxnonna23.bsky.social .

Problem here is - especially in places like ours (India), affordability remains a problem - with the amount they spend on a biopsy they could afford 6 months of non immune therapy - so our biopsies are probably- At diagnosis and then only when absolutely indicated #NephJC

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

The 2025 @kdigo.org IgAN guideline quietly redraws the map: new drugs, new thresholds, and a sense that the era of “supportive care only” is finally over #Nephsky #Medsky ✍️Summary by @thekidneywhisperer.bsky.social and @glomerican.bsky.social www.nephjc.com/news/igan-kd...

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

El próximo #NephJC se centra en la guía de nefropatía por IgA. 🎨 Buen resumen visual de @roxnonna23.bsky.social 🌐 Traducido por @dramiliflores.bsky.social www.nephjc.com/news/2025/10...

Fascinating finding: many patients lost chimerism but stayed IS-free. 🤔 This suggests chimerism is a transient 'switch' to turn on tolerance, not the long-term mechanism itself. We urgently need to identify that mechanism for safer weaning protocols. #NephJC

T0J Lets learn about the GVHD - the lethal complication of transfer of immunocompetent cells to the immunosuppressed recipient. #NephJC

T0h A Chimera was an ancient beast with 🦁,🐐, and 🐍 parts. In modern times, genetic chimerism has been used to create immune tolerance. Infusion of donor hematopoietic stem cells & the presence of the cells in the recipient's blood stream, has been shown to induce functional tolerance. #NephJC

T0f Immune tolerance is defined as “a state of indifference or non-reactivity towards a substance that would normally be expected to excite an immunological response.” This is one potential strategy that would allow withdrawal of immunosuppressive medications. #NephJC

T0d Look at the mortality of renal transplant recipients with graft and without graft function. Top 3: 1) Cardiovascular mortality, 2) Infections, 3) Cancers All three of these are aggravated by immunosuppressive drugs (ANZADATA registry- 2300 patients) #NephJC

🎨Beautiful visual abstract by Bogdan Agavriloaei @thekidneywhisperer.bsky.social #NephJC

Check out the insightful summary by Dr Akshaya Jayachandran @nephromommy-akshu.bsky.social and Dr Natalia Nombera @roxnonna23.bsky.social #NephJC

👩🏻 48-year-old woman 📌 History: membranous nephropathy, hypothyroidism, morbid obesity 📈 Admitted for: Massive proteinuria: 10 g/24 h 🧪 Creatinine: 1.4 mg/dL 🟡 Automated urine: no red blood cells We performed urinary sediment and found the following:

Careful flozins, there’s a new multi-tasker in town 😎 #NephJC

The GLP1: good for weight, heart, kidney, diabetes, liver (now approved for NASH/MASH). Starting to eclipse the flozins #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

T1f When nudged, wearers are told to log their BP for 7 days using a BP cuff and then share results with their provider. It is expected over 1 million people with undiagnosed HTN will be notified within the first year!! That’s some real impact…will this be a game changer? #NephJC

Even with new therapies, awareness and control rates worldwide remain low #nephJC

The guidelines point out literature that home BP seems prognostically similar to ABPM and better for repeatability/longitudinal monitoring. We still use ABPM a lot, but for situations where we need more detailed data (BP lability, new target organ damage, unclear if home BPs are accurate) #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

Are electronic health records (EHR) more predictive of disease onset than polygenic scores? Can we transfer EHR-based prediction models between countries? Our study on these questions using 3 biobank-based studies with N>845K, is out in @natgenet.nature.com today: www.nature.com/articles/s41...

It was. The book is focuses on the history of TB, but it’s definitely not historical. In India, it’s our present. TB plagues all communities and classes, and it’s probably nothing to be proud of, that I seem to know and see most of these situations day-in and out ! #NephJC

A key message no matter what your specialty is - uncontrolled DM causing ESRD, smoking induced lung cancer or alcoholic cirrhosis. Every trainee in Medicine needs to be honed on to this as a first step to being empathetic ! #nephjc

The quote - “It reminded me, that when we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. We can do and be so much for each other… But only when we see one another in our full humanity. #NephJC

Green leans into the couplet, "The cure is where the disease is not and the disease is where the cure is not." because that is the whole ball game. #NephJC

One of the most memorable stories was in Chapter 11, Trepidation and Hope. This chapter focused on TB Sanatoriums. The story is told by Gale Perkins who was 8 and had TB of the bones from eating raw milk. #NephJC

For those of us in medicine, we all know a “Henry” who makes the best of the cards they are dealt, and show amazing strength and resilience. #NephJC

Henry is the story of Vishnu, Ranvir, Prasanna , Lakshmi, David and so many other young men and women whom I see and treat everyday! #NephJC

Even pregnancy sometimes…🤣 During my internship, one patient’s wife chose to conceive because they feared the husband wouldn’t survive his extra-pulmonary TB and wanted an heir. Ironically, he did survive so TB really is everything. #NephJC

It’s 9 PM Tuesday. Welcome to The #NephJC Summer Book Club! Thanks for joining to discuss ‪@johngreensbluesky.bsky.social‬ 's book ‘Everything is Tuberculosis'

Our research on urinary sediment has been accepted as a poster at #KidneyWeek 2025 🩺🔬. Careful analysis of sediment remains key to diagnosis and management in nephrology. @roxnonna23.bsky.social #TeamNefrologiaAlmenara #Urinalysis #ASN #Nephrology

Nephrologists relate to Dune's Fremen because like the Fremen, everytime we meet a patient we frame them up by how much water they contain www.youtube.com/watch?v=8PuL...

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

9/ I want more info ✅ Check out #NephJC summary by @nephromommy-akshu.bsky.social ‬ @roxnonna23.bsky.social @glomerican.bsky.social www.nephjc.com/news/egfrdiff ✅Visual abstract by @nephromommy-akshu.bsky.social @drsaivani.bsky.social www.nephjc.com/news/cricdiff

Big thanks to @drsaivani.bsky.social for working with me on the VA and @roxnonna23.bsky.social for catching what my overcaffeinated eyes missed. 🧠 Shoutout to @assadsm.bsky.social - the quiet force behind my chaos. ✨ #NephJC

Everything said and done - although eGFR diff may signal ominous outcomes - practically speaking following one eGFR over time and seeing the eGFR fall predicts outcomes better than anything else ! And that’s what would be feasible across economies ! #NephJC

Grateful to have also chipped in on the summary and the VA! ✍️📋 There's so much to learn and know, and it all happens outside of your comfort zone. This is Akshaya, (@nephromommy-akshu.bsky.social) signing off after an amazing #NephJC chat ! Catch you later—go rest those neurons! 👋 2/2

T4a Strengths #NephJC 🔄 Simultaneous eGFR & mGFR, and other putative determinants 📆 Long follow-up (~10 yrs) for outcomes of death and hospitalization 📈 Bias analysis of eGFRcr & eGFRcys, and their association were calculated

T3c 🤔Does mGFR = eGFR? Nope 📉Imprecision: eGFR fluctuates when measured repeatedly 🔁 📊Systematic Bias: nonlinear relationship between the filtration marker & how GFR is mathematically represented (over-simplification) 🧮 Does this matter clinically since it is only an “estimate”? #NephJC

This is a really good point. Both eGFRs can be distant from mGFR, or one closer than the other. Isn’t correlation with mGFR more important than eGFRdiff? Maybe, but that’s not what this study was examining #NephJC

T2k Now the kicker: 📊 Final model with all determinants (muscle mass, inflammation, shrunken pore, BMI, etc.) only explained 36% of eGFRdiff variance (R² = 0.36). Steroids? No significant effect (p = 0.55). 🧠 Lots still unknown. Any hypothesis? #NephJC

I see that most of our indian Patients, where we use Cystatin C for donors pre-Tx and recipients post renal transplant - at almost all settings we have seen that Cystatin C eGFR is ALWAYS lower than Creatinine eGFR ! #NephJC And I go with - Neither rock / but the combo probably rocks !!

That’s impressive. So is eGFRdiff just another marker for “inflammation”? High=less inflamed, low/negative=more inflamed with worse outcomes. #NephJC

The results beg a huge question - the patients who belonged the negative quintile and had the worst outcomes - also had poorer mGFR (48ml/min mean) (Iothalamate) - (Vs 68 in the positive group) so what part of the poor outcomes were because of their low GFR per se? #NephJC