Arshad Ali

va

steroid reduction in GN

www.kireports.org/article/S246...

excellent review by ottawa GN group in @kireports.bsky.social @michael-toal.bsky.social and team

(A) Diffuse medium and small renal arterial stenoses (yellow arrows) and microaneurysms (red arrows). (B) Intact large abdominal vessel angiogram and a small splenic artery aneurysm (red arrow in inset). (C). Distended arteriole occluded by a thrombus (arrowhead), consistent with thrombotic microangiopathy (PAS stain, ×200).

#Quiz from October 2025:

A 16-year-old male patient presented to an ED with a 3-week history of progressive headaches, nausea, vomiting, and bilateral blurry vision. Over the past 3 days, he developed chest pain and shortness of breath.

bit.ly/47iQnEo

A Man with Asymptomatic Hypertension Sarah Gorey, M.B. You are the intern on call for the night shift. You are paged to come to the surgical ward to assess a patient. A 63-year-old man with uncomplicated diverticulitis was admitted earlier in the day for antimicrobial and conservative treatment. He rarely visits his family doctor, is not aware of having high blood pressure, and does not take regular medications. You have been called because on a routine check of vital signs, the patient’s blood pressure was 185/115 mm Hg. All other vital signs were within normal limits. The patient has no symptoms; he has no headache, dyspnea, or chest or abdominal pain. He reports feeling slightly stressed at being admitted to the hospital today, which he was not anticipating, but had been sleeping comfortably before the nurse checked his vital signs. On examination, he appears to be comfortable, and there is no clinical evidence of withdrawal from alcohol or other substances. His abdomen is soft and nontender, and on auscultation, no bruits are heard over the aorta or renal arteries. His pulses are 2+ and symmetric in all anatomical distributions. You note that his blood pressure was also high (166/97 mm Hg) at admission 4 hours earlier and had not been measured again until now. Routine laboratory test results from blood samples obtained at the time of admission show increased levels of leukocytes and inflammatory markers but normal kidney and liver profiles. The nurse manager confirms that the blood-pressure monitors on this ward have been calibrated recently. A repeat blood-pressure measurement obtained after the patient has rested quietly for 10 minutes is still elevated, at 182/103 mm Hg. You must decide whether the patient’s blood pressure should be monitored over time on an outpatient basis (a “watchful waiting” approach) or whether he should begin receiving antihypertensive medications during this hospitalization.

Should we be treating inpatient hypertension?

Interesting case with two discussants (Michael Rothberg vs Tara Chang)

www.nejm.org/doi/full/10....

I have to confess despite being a nihilist for treating inpatient BP I am tempted to do something in this setting.

The December 2025 issue is available now: bit.ly/43SrjDd

Highlights:
- Intronic and Coding Genetic Variants in Autosomal Recessive Polycystic Kidney Disease Among Israeli Bedouins of Arabian Peninsula Ancestry
- Nephrologist Perspectives on Using Telemedicine During In-Center Hemodialysis

T0j: #NephJC

The ORIGIN phase 2b trial

👥 116 patients with biopsy-proven IgAN and persistent proteinuria despite RASi

💉 Weekly atacicept 150 mg (wk 36)
⬆️ 35% greater UPCR reduction vs placebo
⚙️ a mean eGFR benefit of +5.8 mL/min/1.73 m²

pubmed.ncbi.nlm.nih....

T0f: #NephJC
1️⃣In IgAN, mucosal dendritic cells activate Tfh cells and directly drive B‑cell class switching via BAFF and APRIL, generating pathogenic IgA ☠️

2️⃣The expansion and mis‑trafficking of Gd‑IgA1+ B cells 👉 excess circulating Gd‑IgA1

pubmed.ncbi.nlm.nih....

a group of men standing in front of the words the cure ALT: a group of men standing in front of the words the cure

#NephJC It’s Tuesday I’m in love?!

T0c: #NephJC

First, the guideline seems outdated. Until now, we aimed to slow CKD progression 🐌, but what if we look from a more daring perspective? Like oncologists/ rheum…

With armamentarium we have now, we can aim for remission 🛑, dare I say “cure”?

pubmed.ncbi.nlm.nih....

Thank you 🙏

Attacking the Origin of IgAN: ORIGIN3 and Atacicept — NephJC This week, we will discuss the phase 3 ORIGIN3 trial of atacicept, an APRIL/BAFF inhibitor for use in IgAN.

✍️Check the insightful #NephJC summary by @notjustdialysis.bsky.social

Arshad Ali, Michigan
No COI
love this topic
#NephJC

Mouse Alport podocytes are susceptible to AAV9 transduction in vivo

doi.org/10.1016/j.kint.2025.09.027

#MedSky #NephSky
@jeffminerphd.bsky.social @washunephrology.bsky.social @washumedicine.bsky.social

EDITORIAL by Pascale Khairallah, Elizabeth Lorenz, and Puneet Sood:

Rethinking Transplant Care Through a Sex- and Gender-Based Lens

bit.ly/433XPly (FREE)

Freely Filtered dives into ACHIEVE with Mike Walsh. This was a great episode. Also with show notes, chapters, and key images (if your podcast client supports it) www.nephjc.com/freelyfilter...

💗 Loved this episode. The puns were great, the trial story is even better! What really stood out was the resilience behind it.

✨Five tries to ACHIEVE the first grant, then 11 in total

T0c
There have been numerous developments in the field of transplantation that have improved outcomes and success rates. Today 95% of renal transplants are functional after 1 year, and 80% at five years. #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

Arshad Ali, Michigan
No COI
#NephJC

Reminder that primary hyperparathyroidism can be a cause of hypertension!

Urinary C-X-C-motif ligand 9 (CXCL9) in immune checkpoint inhibitor-associated acute interstitial nephritis Immune checkpoint inhibitor-associated acute interstitial nephritis presents significant clinical challenges. There are no reliable non-invasive biomarkers and kidney biopsy remains the gold standard ...

Urine CXCL-9, now in immune checkpoint inhibitor AIN! In @kidneyint.bsky.social

www.kidney-international.org/article/S008...

Her serum creatinine has been around 0.7 all along. Over last 2-3 years she had noticed a trend going up and was referred to evaluate. Genetic testing we orderly routinely for this subset of patients who have no known etiology. Agree at this time we would just not do anything.

Agree!
She had no problematic pregnancies.

What is your leading diagnosis when seeing this interesting IgG staining pattern by IF? 

#DiagnoseThis #pathology #renal #kidneypath

George Medicines announces FDA approval of WIDAPLIK™ (telmisartan, amlodipine and indapamide), a new single pill combination treatment for hypertension in adults, including initial treatment Novel, single pill, triple combination with a standard dose and two lower doses that can deliver the efficacy benefits of combination therapy, with an established safety profile and good tolerability ...

Triple drug combo now available in US - approved by FDA

Telmisartan 10
Amlodipine 1.25
Indapamide 0.625

george-medicines.com/george-medic...

#Hypertension
#Widaplik

Also in higher doses:
20/2.5/1.25 and
40/5/2.5

Machine Perfusion in Deceased Donor Kidney Transplantation: Editorial Summary of a Cochrane Review by @samjtingle.bsky.social and Colin Hugh Wilson

bit.ly/AJKD25Tingle... (FREE)

Serology including ANA , C3C4 ANCA are all normal.
No other signs or symptoms.
Other than actual measuring Factor H levels and vaccinations and treating infections, is there any role for Eculizumab in such patients.

@askrenal.bsky.social

How do you manage a 70 yr old female with stable renal function with serum creatinine at 1.12 with positive heterozygous CFH complement factor H deficiency on genetic testing with urine sediment showing oval fat bodies with no proteinuria or hematuria. UPCR/ UACR negative.

Suzetrigine: Is It A Safer Pain Medication For Patients With Kidney Disease? Pain management in patients with chronic kidney disease (CKD) is complex. Widely used analgesics like opioids, NSAIDs and gabapentinoids may directly or indirec

Suzetrigine: Is It A Safer Pain Medication For Patients With Kidney Disease?

www.renalfellow.org/2025/05/02/s...

He Was Sure Dialysis Had Caused His Belly Pain. But Why? The patient’s symptoms had sent him to the emergency room 22 times in the past year.

Cool diagnosis in a dialysis patient

www.nytimes.com/2025/05/02/w...

@rmcentor.bsky.social in the NYT

H/t @doctorajgu.medsky.social

#NephSky

Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension | NEJM Aldosterone dysregulation contributes to hypertension. Lorundrostat is an aldosterone synthase inhibitor, but data on its efficacy and safety in patients with hypertension are limited. In this mult...

The ASIs have arrived

www.nejm.org/doi/full/10....

Aldosterone synthase inhibitors - first one to finish the phase 3 line

#Lorundrostat #Hypertension