Natalia Nombera Aznaran

Great chat Saivani 🤩

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

Good question

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

For now, the key is prevention of kidney disease #NephJC

Achieving immune tolerance by chimerism in kidney transplant — NephJC Is getting immunosuppression-free a chimera in kidney transplant? Check out the visual abstract by Bogdan Agavriloaei

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

Chimerism and Immune Tolerance: Can We Says Goodbye to Immunosuppression? — NephJC This week, we will discuss the use of creating chimeras to induce immune tolerance and its potential to decrease or eliminate the need for immunosuppression in kidney transplant recipients.

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

Hi! Natalia Nombera, research scholar from UAB #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 sun is partially obscured by the moon during a solar eclipse ALT: the sun is partially obscured by the moon during a solar eclipse

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

good list! i think since a pt is diagnosed, is important to always look for end organ damage! #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

a black and white drawing of a funny face with a tongue sticking out on a white background . ALT: a black and white drawing of a funny face with a tongue sticking out on a white background .

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

still used a lot back in peru, although more focused when there is variability, resistant hypertension, etc #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

agree! should be more focused on cv kidney risk reduction, bp goals, and there is inconsistency in the threshold around the world #NephJC

Hi, Natalia Nombera - nephrology research fellow, excited to be here 😀#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...

Cross-biobank generalizability and accuracy of electronic health record-based predictors compared to polygenic scores - Nature Genetics Comparison of electronic health record-based phenotype risk scores (PheRS) and polygenic scores (PGS) across 13 common diseases and three biobank-based studies indicates that PheRS and PGS may provide...

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...

I think the worst part is maybe for psychiatric disorders - symptoms can be invisible, fear, prejudice, etc, etc. mental health awareness is so important #NephJC

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

I was thinking about hiv too, there are many similarities we can find #NephJC

🥳

Exactly. For me it is the last paragraph in the image: People living with TB have told me that fighting the disease is hard, but fighting the stigma on their communities is even harder. Being isolated from your loved ones and publicly ostracized #NephJC