Assad SM

Do you think it would be possible to get the ethical committee/ trial board approval of your institution to start a long term CV outcome trial on #Flozins in transplant ?

#NephJC

Hi, this is Assad , Nephrologist and transplant physician from India.
No COI.

We have a small cohort of transplant recipients whom we Flozinate, primarily for Proteinuria.

#NephJC

T3d
Benefits may vary, and results in the general population on CV risk and mortality are still
controversial.
Overall, the results of recent studies have been mixed results. Different study populations,
end points and dosing may account for the lack of clarity. #NephJC

Maybe further trials comparing it with Nefecon or Sparsentan - drugs already proven to reduce proteinuria/eGFR slope, would enlighten us better as to which is better, and also help us decide on cost comparison (Albeit, once they’re available here 😅).

#NephJC

Hey I’m Assad, nephrologist working in a high-volume IgAN centre in India !
We’re still like the KDIGO guidleimes though - a bit outdated as we come up !
Probably it’s the cost of these drugs and their availability which limit us !
No COI
#NephJC

Title slide

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/

Interventions

These are the interventions:
- SoC alone
- Low dose steroids
- Gut directed (NOT targeted release) budesonide
- MMF
- Hydroxychloroquine
- later Finerenone once generic in India

Great choices!

#NephSky #ISNWCN
4/

Treatment in children: 👶💉
Management is based on RAS blockade, salt restriction, and blood pressure control. Glucocorticoids are used in those with persistent proteinuria or high-risk features, sometimes combined with cyclophosphamide in severe cases.

#NephJC

Yes my exact opinion, guidelines may be evolving and improving but what happens in reality?

Our patients either come with a creat of 8,
Or they’re loaded with steroids for quite long without even SGLT2i or ARBs many times, and they’re just victims of therapeutic misadventure.
Sorry state. #NephJC

Non-immunologic therapies also have important disease-specific benefits that are often underused.
#NephJC

In countries like India, drug sales, doses, and indications are poorly regulated → frequent misuse.

#NephJC

Hey this is S M Assad, Assistant Prof Nephrology from CMC Vellore !
#NephJC

In India, many with IgAN present late and do poorly—limited access, high costs, and low awareness keep outcomes far behind what they could be. Also the fact that the eGFR slope is somehow too deep.

No COI

Protein powders for CKD - like NeproHP/ RenHP are a fad ! They have a very poor protein density with increased carbs and cost much more than what they’re worth !
The costs are exorbitant - more so considering our patients’ economic state!

#NephJC

Yes, our practices are changing. But most of our patients go to their “local doctor” or Ayurvedic doctor who again says that if they take less protein their kidneys can be saved - again highlighting the gross misconceptions among treating physicians too ! #NephJC

a man in a suit and tie is eating broccoli from a person 's hand . ALT: a man in a suit and tie is eating broccoli from a person 's hand .

Hey this is Assad, nephrologist from Christian Medical College, Vellore in India.

We tend to restrict proteins in our patients, and they go a few steps further stopping all protein altogether - ending up cachexic. Change is warranted. Most of our patients are traditionally vegetarian too🥑
#NephJC

Great Chat. Big thanks to @nephromommy-akshu.bsky.social and @roxnonna23.bsky.social the crisp #NephJC summary 🙌. Thanks for waking me up Akshaya. Grateful! 🙏

But I don’t see it going beyond the small privileged group of HLA matched patients !

There are too many IFs and BUTs involved
#NephJC

The problem here is that - as attractive as being IS free sounds - it comes with a huge load right from patient selection, ensuring HLA compatibility, putting a huge burden on donors (making the MDR 101) and a very high risk IS withdrawal trial - with risk of rejection for the KTRs #NephJC

Let's remember operational tolerance isn't always induced. Some patients, especially HLA-matched can already come off IS without MDR-101. We need better biomarkers to find these "spontaneous tolerants." #NephJC

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

The conditioning regimen (rATG + TLI) is a big deal. For non-malignant disease, the risk of severe infections should definitely be considered in depth. Infection risks remain a huge obstacle for routine adoption. #NephJC

This is a once-a-year plea for support #NephJC

Wasn't invited for the twinning photo.
Guess I’ll stick to mixed chimerism in renal transplants for my twinning goals.

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

Hey, I'm S M Assad, young Nephrologist from CMC Vellore, India.
No COI.
While some centers in India have explored steroid-free regimens and local stem-cell work, the complexity and cost of bespoke cell therapies mean we rely on conventional, cost-effective IS as the standard of care. #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

#NephJC Summer Book Club Everything Is Tuberculosis poetry — NephJC Akshaya Jayachandran, NephJC intern was inspired by John Green’s Everything is Tuberculosis to write the following poem.

Beautiful and meaningful poem by
@nephromommy-akshu.bsky.social inspired by @johngreensbluesky.bsky.social's
Everything is Tuberculosis

www.nephjc.com/news/2025/8/...

a cartoon llama says " much appreciated " with its hands folded in prayer ALT: a cartoon llama says " much appreciated " with its hands folded in prayer

Amazing Chat! A job very well done Akshaya! Have seen your passion and dedication over the past few days! Keep going! #NephJC

Mind The Gap: When eGFR Creatinine and Cystatin C Disagree — NephJC This week, we will discuss the clinical significance of eGFRdiff, the difference in eGFRcys (cystatin C) and eGFRcr (creatinine).

On 7/22/25 at 9pm EST only on Bluesky!
#NephSky #MedSky join us for a lively discussion.
We're debating eGFRdiff (the gap that is sometimes present between the eGFR of cystatin C and creatinine). What does it mean, what causes it and what you should do about it. #NephJC
www.nephjc.com/news/egfrdiff

Insights from the CRIC Study: Visual Abstract — NephJC Based on data from the CRIC study, this analysis dives deep into whether this lab mismatch is just noise… or a clinical signal we’ve been missing. Check out the beautiful visual abstract made by our NephJC interns Sai Vani Yellampalli and Akshaya Jayachandran . Great team work!!!

Check out the VA from @drsaivani.bsky.social and @nephromommy-akshu.bsky.social on eGFRdiff in the CRIC cohort.
#Nephsky #NephJC
www.nephjc.com/news/cricdiff