Research letter, pilot trial from Mayo ($locked)
pubmed.ncbi.nlm.nih.gov/41802270/
Diuretic resistance is mostly inadequate furosemide dose. Torsemide not needed™️
(Incidence of deafness 🧏🏽♂️ not reported)
thanks 😃
There’s talk of targeting immunological remission (normal dsDNA and normal C3/C4) instead of just lowering proteinuria. Do you specifically treat or escalate treatment to target this?
My patient still has high dsDNA despite clinical remission.
Thanks. How often do you dose in maintenance? Seems B-cell depletion last up to a year with obi.
Is anyone using obinutuzumab for maintenance in SLE (I know there is no data)?
Have young pt with LN III/IV, MMF + prednisone induction. Doing well, but persistently high dsDNA, C3/C4 normal.
@kidneydoc101.bsky.social @juancarlosqvelez.bsky.social @kronbichlerlab.bsky.social @grahamabra.bsky.social
indeed, similar effect size to the NefIgArd trial. I’m convinced…
We report it for outpatients
We don’t report it for inpatients - it’s easy to calculate if you want to
Don’t check until next follow-up and don’t hold based an any arbitrary increase in creatinine, go by symptoms.
Don’t hold diuretics either.
No problems so far, knock on wood…
Very cool paper from Hamburg! Urinary CD4+ T cells identify Sjögren's patients with nephritis and help monitor treatment response! Awesome work!
pubmed.ncbi.nlm.nih.gov/41673408/
#NephSky
SGLT2i increases urinary EGF, unknown mechanism
likely related to increased urinary epithelial growth factor (EGF), which stimulates expression of TRPM6 in the DCT through the EGF receptor leading to increased tubular reabsorption of Mg
Glomerular basement membrane (GBM) structural integrity dictates trans-tissu... www.sciencedirect.com/science/arti... Really proud of this Cell Reports paper showing that the potentially pathogenic laminin alpha2 in the Alport GBM comes not from glomerular cells, but from the bloodstream.
Yeah, the science is intriguing and I want to be using it for that reason, but so far we’re sticking with ESA for CKD at my department.
In Denmark, HIFs are priced the same as ESA, so the only argument is convenience and needles, not cost.
Not worried about safety, just doesn’t seem that much of a hassle to use ESA.
Maybe I’m being reactionary, but we have a lot of experience with ESA and don’t see a big need for HIF-PHI.
But then again, I’m not the one getting the injections… 😜
In which situation would you use it?
PD? CKD?
Despite the cool science, I have to agree with @kidneyboy.bsky.social on this…
#NephJC
The things that have changed or most influenced my approach to anemia are:
Daniel Coyne
DRIVE 2
PIVOTAL
CHOIR/CREATE/TREAT
(No KDOQI or KDIGO guideline)
#NephJC
Or seeing a lot of young patients with positive cross-matches and with no other cause of allo-/isoimmunization. If not the principal cause of their symptoms/ death-treatening, I always think twice if it's worth it #nephjc
Completely agree. Same for PLA2R-negative membranous. Recently saw a patient with longstanding disease and gradual remission, then increasing proteinuria. Almost restarted rituximab, but bx showed no deposits, only chronic FSGS lesions.
Proteinuria now in remission after tight BP control.
fair amount of chat on hypertension and AKI/critical care. Not much GN and transplantation.
fun review if anyone is interested www.ahajournals.org/doi/10.1161/...
Vaughan Pendred was a house surgeon at Guy's hospital when he reported deaf-mutism with goitre www.sciencedirect.com/science/arti... in @thelancet.com - and went on to become a ....(not nephrologist) a general practitioner
@dialysisbloke.bsky.social
Applied the VIPAR protocol to a patient with cAMR, first time in our centre.
Fingers crossed for positive results 🤞🏻
Just wanted to let you know that it’s being used out there 🤓
MedTwitter started like this, initially just posting and later developed into bidirectional and interaction. What is the trouble with BlueSky?
Not yet reached critical mass? Or have people in general given up on the bidirectional conversation?
Another trial!
Albumin 20% for septic shock
Does not work - JAMA NO
jamanetwork.com/journals/jam...
#EMIMCC
Have to opine, though. These are not primary FSGS per KDIGO definition (ie. permeability factor), but rather a combination of genetic FSGS, FSGS of undetermined cause, and perhaps a bit of secondary FSGS (despite thorough work-up).
Doubt that TRPC6i will work in an autoimmune condition…
Tough trial to recruit for, but pretty cool mechanism of action, particularly for TRCP6-FSGS.
#OTD 1917 David Finney b (d 12 Nov 2018) CBE FRS; ASA Fellow 1951; Royal Statistical Society President 1973. Pioneered statistical methods of experimental design, statistical computing, pharmacovigilance, biological assay & probit analysis. 1/3
No, not at the moment, so reasonable approach with RTX only for FRNS/SDNS. That’s our practice as well, just curious to hear what others do.
Still interested in the mechanisms of #SGLT2i? I did a video with #Vumedi going through our study on the effects of empagliflozin on fluid and electrolyte balance. check it out: www.vumedi.com/video/fluid-...
Link for the studies 👇
#medsky #nephsky
Agree re CS and CNI for initial treatment, but perhaps RTX in addition to these? It is being tested in the UK, but don’t know the status of the trial.
link.springer.com/article/10.1...
In Denmark 1 g of RTX x 2 (biosimilar) comes to approx $2,500 US, so low cost for us
Do you ever use RTX as part of initial treatment or only for FRNS/SDNS?
Sometimes wonder if we should just give RTX up front given the relatively low cost and safety.
