Alex Chang, MD

Am I the only one that doesn’t really like using AI abridge for notes?

How Many Times Can Science Funding Be Canceled? Whether or not Congress cuts NIH’s budget, the Trump administration has devastated its ability to operate.

"Its political leadership has shredded the NIH playbook so thoroughly, current and former NIH officials told me, that even at current funding levels they are unable to perform their core work of vetting and powering some of the best research around the world." www.theatlantic.com/health/archi...

Are Calcium-based Phosphate binders bad? A Rant/Commentary — NephJC How strong is the evidence against calcium based PO4 binders? Swap breaks it down in his usual style

That sevelamer versus calcium box in the figure above? The hats driven by the fraudulent Di Iorio et al trials that CJASN and AJKD mistakenly published

See our critique here

www.nephjc.com/news/landmar...

#NephJC

Question to the transplant nephrologists on here: what is your stance on GLP1-RA in transplant patients 🤔
Safe during long term follow up if all else stable, perhaps after Year 1? Or has anybody seen severe issues or rejection due to low Tac levels?

Creative finch nest

Added!

Collagen IV in Gould syndrome and Alport syndrome Nature Reviews Nephrology - In this Review, the authors focus on the role of collagen IV in Gould syndrome and Alport syndrome. They discuss the molecular and phenotypic similarities and...

Thrilled to have this finally published! If you are interested in learning about the collagen IV diseases Gould syndrome and Alport syndrome, add this to your reading list. www.nature.com/articles/s41...

a cat wearing glasses and a bow tie is sitting on a laptop ALT: a cat wearing glasses and a bow tie is sitting on a laptop

In order to understand and communicate about the implications of this multi-year funding scheme, I put together a simple computer simulation.

1/n

Awesome infographic on genetic testing in ADPKD by Neera Dahl, @pranavgarimella.bsky.social and Fouad Chebib www.kidneynews.org/view/journal...

Yes, I think that’s an important piece e of evidence that the proteinuria is a primary problem and reducing it is beneficial

Albumin contributes to kidney disease progression in Alport syndrome - PubMed Alport syndrome is a familial kidney disease caused by defects in the collagen type IV network of the glomerular basement membrane. Lack of collagen-α3α4α5(IV) changes the glomerular basement membrane...

Also interesting model to study albumin role in kidney disease: knockout Alb mice in Alports - lack of filtered albumin resulted in improved kidney disease outcomes and lifespan. "conclude that filtered albumin is injurious to kidney cells in Alport syndrome.." pubmed.ncbi.nlm.nih.gov/27147675/

Alterations in the Plasma Protein Expression Pattern in Congenital Analbuminemia—A Systematic Review Albumin is a highly abundant plasma protein with multiple functions, including the balance of fluid between body compartments and fatty acid trafficking. Humans with congenital analbuminemia (CAA) do ...

@sarahkmels.bsky.social re questions on albumin. Working on a related genetic paper and came across interesting papers on congenital analbuminemia (1 in a million) with seemingly pretty healthy pts (though limited data on long-term f/u). pmc.ncbi.nlm.nih.gov/articles/PMC...

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

Whoa moth

As Jay said, many of the #BethesdaDeclaration signers will meet with him on Monday. And oh boy are we prepared!

While not every signer was invited, we worked together and with our colleagues across #NIH to bring our concerns—and evidence to back them up.

Buckle up, this will be a long thread. 🧵

Proud that we have officially received certification as an AHA Comprehensive Hypertension Center!

2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults

08/28/25 @ 12:00 pm – 1:30 pm CDT
Featuring writing committee members and highlights from the
ACC/AHA Committee on Clinical Practice Guidelines
targetbp.org/event/target...

a man in a suit and tie is saying let 's do it . it 's go time ! ALT: a man in a suit and tie is saying let 's do it . it 's go time !

Pumped up that we now will be able to offer a 4-year accelerated Infernal Medicine/Nephrology fellowship track at Geisinger Medical Center! acgmehelp.acgme.org/hc/en-us/art... @kkalra.bsky.social

Thanks Alan!

Primary Aldosteronism A new Endocrine Society guideline on Primary Aldosteronism updates a 2016 guideline, and suggests that everyone who is diagnosed with hypertension have their levels of aldosterone, renin, and potassiu...

Guidelines no longer recommend holding typical first-line antihypertensive meds since renin will most often still be suppressed despite being on them in true PA. Growing evidence supports proceeding with screening

Hot off the press from the Endo Society: www.endocrine.org/clinical-pra...

Happy to share our paper on Genomic biobanks generating Insights into Genetic Kidney Disease" (shareable link next 50 days)
Biobanks + clinical data -> drug discovery,
Informing risk in complex dz, clarify what we know of monogenic dz, resolving VUS
kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...

Yes I wonder about the PDC accuracy too but wouldn’t that imply they aren’t taking those meds regularly if they have several bottles of it on their shelf?

FF 81 Metformin Termination as explored by Target Trial Emulation — NephJC Metformin Termination as explored by Target Trial Emulation

The latest episode of @freelyfiltered.bsky.social is outstanding. If you are confused about target trial emulation and think of it as a statistical black box, I encourage you to take a listen. @jordybc.bsky.social and Ed Fu do a brilliant job of explaining it.

www.nephjc.com/freelyfilter...

Medication nonadherence is common in HTN and can be detected electronically. In this RCT, combined team-based primary care w/automated identification of pts with antihypertensive medication nonadherence did not lead to improvements in adherence or blood pressure.
cdn.jamanetwork.com/ama/content_...

Yesterday, marked 1 month since we sent the #BethesdaDeclaration.

So, has anything changed? 🧵 1/n

High or low BMI may influence the accuracy of eGFR. This #ASNJASN study finds indexed eGFRcr-cys to be more accurate than eGFRcr or eGFRcys across the BMI spectrum, improving GFR classification and treatment decisions. kidney.pub/JASN0760 @alexchangmd.bsky.social

Just learned Plural of nephronophthisis is nephronophthises - thank you pediatric nephrologists!

This is nuts, a $35-per-treatment copay for dialysis and CKD patients above the poverty line could cost dialysis patients over $5,000 annually

*Quickly checks show of hands at the unit, anyone got $5K?, No one? Ok cool cool I’ll let them know*

Acute Kidney Injury in Hospitalized Patients With Exertional Rhabdomyolysis This cohort study estimates the incidence of acute kidney injury (AKI) in patients hospitalized with exertional rhabdomyolysis and identifies factors associated with development of AKI in this populat...

Interesting exertional rhabdo article - only 8.5% developed AKi. Pre-admission NSAID and dehydration associated with AKI risk whereas no association between CK level and AKI risk

jamanetwork.com/journals/jam...

In the shooting of an Indiana kidney doctor, fresh echoes of the UnitedHealthcare murder and the specter of vigilante violence Long-running questions about kidney dialysis don’t justify shooting, prosecutor says

Florida man (medical resident) shoots an….Indiana Nephrologist?

This story seems nuts www.cbsnews.com/dialysis/

h/t @vijayanmd.bsky.social @grahamabra.bsky.social

#NephSky