Join the Filtrate and Jon Barratt as he takes an IgAN inspired victory lap FF 86 Atacicept for IgAN www.nephjc.com/freelyfilter...

I’m a little shocked at this review of resistant hypertension in CKD. academic.oup.com/ckj/advance-... - Weird take on BP targets (there are other trials besides SPRINT) - Thiazides don’t work in CKD, except chlorthalidone (demonstrably false) - Don’t use spiro if eGFR <45 because hyperK ?!?!? 1/2

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:

Diagnosis unmasked. Young F with 2g proteinuria, weak +dsDNA. Membranous pattern, IF with C3 dominant staining. Pronase IF --> IgG-k. Membranous-like glomerulopathy with masked monotypic IgG-k deposits. Considered to be autoimmune; not MGRS. #renalpath #pathsky #nephsky.

Neuronal proteins show up in so many of our proteomics and mass spectrometry experiments on renal tissues and cells, especially the podocyte! Larry Beck and Laith Al-Rabadi discuss this in the context of MN here.

Nothing works in dialysis - except fis oil. Truly amazing data from the PISCES. Should we begin perscribimg fish oil supplements to all our dialysis patients? In spite of my somewhat sceptical priors, I think the answer should be “yes” #NephSky #KidneyWk #nephrology

Not all heroes wear capes. xkcd.com/3163/

What mechanisms drive checkpoint inhibitor-associated interstitial nephritis (ICI-AIN)? In our preprint, we identify CD8 T cells as a central player, inducing a proinflammatory myeloid cell state by IFNg and structuring lymphoid aggregates by CXCL13. www.biorxiv.org/content/10.1... 1/n #Nephsky 🧪

After a 40 minute handa on session where my station worked on kidney US we are back in the lecture room for a talk on lung ultrasound by Nathaniel Reisinger #KidneyWk

I enjoyed the Observer this morning @drjennings.bsky.social In my considered view politicians and public bodies should not be on Twitter is for the same reason that a candidate should not attend a townhall meeting where he was put on a lower chair and very loud music played whenever he spoke.

Clinic visit, pt w/type 2 diabetes + nephrotic range proteinuria. Persistent hematuria noted (normal cysto 3 mo ago) not c/w diabetic nephropathy. #UrinarySediment 🔬is performed: numerous acanthocytes and a few WBC casts. Serum IgA elevated. Normal C3/C4. Other tests pending. Kidney biopsy planned

New episode of Freely Filtered with @brendonneuen.bsky.social @hswapnil.medsky.social @captainchloride.bsky.social @sophia-kidney.bsky.social and author Muth Vaduganathan discussing the CONVINCE trial www.nephjc.com/freelyfilter... With chapters, refs, and pictures

A little opinion piece on the relationship between serum calcification propensity (T50) and progressive CAC in kidney transplant recipients 🤓 www.kireports.org/article/S246...

And it’s live Iptacopan in C3GN makes it to @thelancet.com www.thelancet.com/journals/lan... #NephSky

Wide variety of morphologies in this case of crystalline light chain proximal tubulopathy: mottle lysosomes, crystals, and fibrils. #renalpath #nephsky #pathsky

Have hyperglycemia (and other DM badness) been hiding in plain sight in ESKD? Probably. Great study using CGMs in ESKD. Pts with treated DM, mean TIR only 43% while mean HbA1c was 7.0% journals.lww.com/jasn/abstrac...

RIP Nicolas Madias Of the Adrogue-Madias formula and much more I don’t know he wrote three textbooks as a medical student! www.kidney-international.org/article/S008... In @kidneyint.bsky.social #NephSky

Now online in @ndt-era.bsky.social Perlecan is a novel target of autoantibodies in anti-glomerular basement membrane disease 🧐Triple-positive pts (anti-type IV collagen, -laminin 521, and -perlecan) = highest prevalence of lung hemorrhage and ESKD ▶️ academic.oup.com/ndt/article-...

Does anyone have experience with RTX for anti-GBM disease? Specifically, elderly/frail patients with anuria and no DAH. Kidneys lost, but high risk with CYC. Systematic review in KI Reports doesn’t entirely answer my Q @juancarlosqvelez.bsky.social @kronbichlerlab.bsky.social @lastwalsh.bsky.social

Amazing! New species = new DNA to sequence = new knowledge = new breakthroughs at the horizon . Science won’t stop

Isidore Edelman, father of the Edelman formula was a victim of McCarthyism. Lost his grant and federal funding after being accused of being Red. The American Heart Association stepped up to back fill his funding which allowed him to continue his work on salt and water

We often now hear the term “Bayesian borrowing” in trials. But what is Bayesian borrowing and what are the pros and cons around its use? 1/6 #MethodologyMonday #122

Reduction in all-cause hospitalisation driven by fewer admissions for: - Cardiac - Renal - Metabolic disorders, and - Infections Interestingly reduction in infections also observed with semaglutide in the FLOW trial - could GDMT improve physical resilience & susceptibility to infections?

In resistant HTN guidelines say RAASi + CCB + thiazide followed by spiro. When BP at target, do you try discontinuing the first 3 and ramp up spiro? Or leave them on 4 drugs? (obviously first rule out primary hyperaldo) @hswapnil.medsky.social @drjmluther.bsky.social @jordybc.bsky.social

SGLT2i in CKD: impact beyond kidneys 🔻 15% all-cause hospitalizations ✅ Consistent regardless of eGFR, UACR & diabetes 🏥 ~36 fewer hospitalizations per 1000 pt-years Large absolute gains for patients & health systems Meta-analysis in @asnpublications.bsky.social journals.lww.com/cjasn/pages/...

“Lasagna’s Law” describes the often observed phenomenon that as soon as you start your clinical trial the number of potentially eligible patients you expect to see/recruit suddenly appears to plummet. 2/7

RIP Alan Jardine journals.lww.com/jhypertensio...

Proud to have contributed to our ERA Genes&Kidney working group consensus statement on CKDx (X for unexplained cause) published in #NDT. Transparent classification is of great benefits for patients and accelerates research ! academic.oup.com/ndt/advance-...

🔥 Final (pdf) version available online (free): Mass Spectrometry With Data-Independent Acquisition for the Identification of Target Antigens in Membranous Nephropathy @ajkd.bsky.social ➡️ doi.org/10.1053/j.aj... #OpenAccess 🙏 to all collaborators and sponsors!

Grateful for the opportunity to work with such a team — to expand the original technique of laser capture microdissection and mass spectrometry for the identification of target antigens in membranous nephropathy ✨

I've been told to be more uplifting when I do science communication stuff. Someday. But today is not that day. I'd like to tell you about yet another way the US lags the developed world in healthcare. Let's talk about "avoidable deaths". (thread)

Have to agree, unfortunately. Don’t feel safe going anymore…

Is there any proper data to support this? Does it achieve anything other than polyuria?

Excited to see this finally in press! Special thanks to @hswapnil.medsky.social for invitation and coauthors Abdulghani Kabli, Oleksa Rewa, Ted Clark. #canada. Special thanks to my role models Etienne Macedo and Ravi Mehta whose prior version we built upon. #nephsky #medsky #emimcc rb.gy/8kke9h

1/ Thrilled to share our latest work ‘Mass Spectrometry with Data-Independent Acquisition for the Identification of Target Antigens in Membranous Nephropathy’, just published in @ajkd.bsky.social www.ajkd.org/article/S027... #CHUUCLNamur #deDuveInstitute @inserm.fr #UCLouvain #CuSL A thread

Mass Spectrometry With Data-Independent Acquisition for the Identification of Target Antigens in Membranous Nephropathy #nephsky www.ajkd.org/article/S027...

Who knew? That was sarcastic. @jordybc.bsky.social @hswapnil.medsky.social jamanetwork.com/journals/jam...

Agree. Would almost always opt for a better agent. *Except* I recently learned it’s the only RAS blocker that’s thought to be semi-ok while breast feeding! www.ncbi.nlm.nih.gov/books/NBK500...

#askrenal Just been told that enalapril 10 mg is max dose for HTN, but label says up to 40 mg per day. Anyone know the RCT data on enalapril in HTN? @hswapnil.medsky.social @jordybc.bsky.social @drjmluther.bsky.social

If you were on social media during the pandemic, you came across #DiedSuddenly. Stories of young people, healthy, suffering fatal cardiac arrest out of nowhere. The implication? Those evil vaccines. It was all bullshit. But I want to talk about why it was so effective. 🧵

1/3 This Cochrane review states: “Intensive screening for the early detection of BKviraemia or BK viruria prevents graft loss”. But this is highly flawed www.cochranelibrary.com/web/cochrane...

Ongoing late posts from @theisn.org #ISNWCN from the high impact trial session - this was a great study design The India ALLIANCE GRACE IgAN trial Lead by Succeena Alexander from CMC Vellore #NephSky 1/

Just out. Work done my excellent nephrology PhD Fellow Elisa Bongetti. Effect of equation change in the well elderly. Curing a few of CKD….

And not the only IL-6 CV outcome trial in CKD! POSIBIL6-ESKD: clazakizumab 5mg monthly vs placebo in dialysis N=2,200 PEP: MI or CV death P2b results also demonstrate 90% reduction in CRP www.nature.com/articles/s41... And improvements in iron metabolism: journals.lww.com/jasn/citatio...

In case you missed the poster session this morning #ISNWCN APPEAR -C3G trial results showing promising at 12 months ✨Nice seeing @profnickwebb.bsky.social

Hello #hypertension peeps- Which of the following NSAIDs do you think is the least bad option for a patient on either a CCB or BB who needed daily Rx for joint pain: -ibuprofen -naproxen -celecoxib -something else? #medsky #nephsky (#bluesky needs to add a poll option....)

We've frustratingly allowed "real world" to become a deceptive synonym for "observations we happened haphazardly to make". I'd say half the studies that come to me now, the majority of which are useful but modest clinical audits, will have "real world" in the proposal title. It's magic!

Suggested New Year's Resolution: more mindful prescribing of IV fluids 🫧 Far too often I see IV fluids thrown around with minimal consideration; meanwhile, we'll deliberate for hours about a dose of lasix 🤦‍♀️ Here are the 10 most common fluid prescription mistakes I see 🧵 #emimcc