Discover and read the best of Twitter Threads about #Nephjc

Most recents (24)

Welcome to #TenTweetNephJC
✳️10 tweets #NephJC catch-up ✳️

In the last NephJC, we discussed interim results📊from the PROTECT trial on efficacy & safety of Sparsentan in IgAN.

New light✨on the horizon for IgAN yet?

Check out this flying summary in case you've missed the chat! Image
2/10
What did I miss?

3 decades of fateful trials of ERAs in PAH, HTN, DKD, FSGS & IgAN (AFFINITY,ALIGN) set the stage for

🛡️PROTECT🛡️
Sparsentan🎲Irbesartan
thelancet.com/journals/lance…

✔️Phase3⃣RCT
✔️Active-controlled
✔️Double-blind🚫

✔️18 countries🗺️
✔️134 sites🏥

The cohort⬇️ Image
3/10
1 tweet methods

n=406
270 weeks (114+156 weeks open label with SGLT2i!)

➡️Carefully selected population for nil significant cardio/cerebro-vascular or hepatic disease
➡️On MLD/50% MLD of RAASi
➡️1:1 randomisation
➡️Stratification as per eGFR & proteinuria
➡️MMRM statistics Image
Read 11 tweets
Welcome to #TenTweetNephJC for a short recap! Nephrologists warned of renalism neglecting cardiac ischemia in kidney pts. ISCHEMIA-CKD dashed hopes. Waiting for a deceased donor kidney transplant in the US is a grueling journey for +100K pts with advanced chronic kidney disease Image
2/10
What did I miss?
🌤️Retrospective study: asymptomatic kidney transplant candidates tested for coronary heart disease (CHD) vs non-tested pubmed.ncbi.nlm.nih.gov/36595271/
Aim: to determine the effect of CHD testing on the risk of death or acute MI within 30 days after transplant
3/10
1 tweet methods

⏪ Retrospective cohort study, USRDS, 2000-2014

✅ 79334 Adults, 1st time kidney transplant

✅ CHD testing 12 months before transplant

🛠️ Instrumental analysis variable - less biased by confounding than standard methods @Husamjz ImageImage
Read 11 tweets
#1
A few hours to go for the #NephJC chat on the MYTEMP trial ⏳

❓Have you ever paused to wonder how we came up with the ‘standard’ dialysate temperature of 37°C (98.6°F)???🤔

❓How does core body temperature (CBT) differ in dialysis patients from the general population?🤔
#2
👉Historical reasons for std dialysate 🌡️seem unclear

👉37°C considered avg body 🌡️in adults ⏩ arbitrarily selected as ‘neutral’ dialysate 🌡️

👉Assumed to prevent body 🌡️ changes during HD

#NephJC

pubmed.ncbi.nlm.nih.gov/15211448/
#3
❓How did we come up with 37°C as the normal body 🌡️?

👉From Dr. Carl Wunderlich
▶️Father of clinical thermometry
▶️Analyzed >1million axillary 🌡️from 25K adults (pre-digital era!🤯)
▶️Noted 🌡️differences with race, sex, circadian rhythm
#NephJC
pubmed.ncbi.nlm.nih.gov/8011836/
Read 7 tweets
🧵1/ A nephrologist's retrospective
🤔This is the result!
Among talented, dedicated people I was nominated, I somehow won. I felt humble and shocked... So unreal, trying to understand why my name is there
#NephjCkidneys #NSMC

nephjc.com/news/2022/11/5… Image
2/ 🧵Here it starts, in Jan 2022:
Hi, my name is Cristina, and I'm a🇷🇴nephrologist, too shy to stand out in a crowd, lost after finishing my residency. Teaching, the idea of continuing my Phd made me keep my head above the water
Too busy with life, constantly seeking
3/ I got over myself and made courage to pursue the thought I had a few months before -> #NSMC
After waiting impatiently, I got my answer through this mail ✨ Image
Read 12 tweets
Diuretic management in decompensated heart failure has been stagnant for years but recently we have some new tools to help us out.

Let's review the Rise of the Proximal Tubule Inhibitors in preparation for the #nephjc discussion on ADVOR tonight.

#MedTwitter @MedTweetorials
First, it's important to recognize how crucial adequate decongestion is.

👇study: pubmed.ncbi.nlm.nih.gov/29544928/ which assessed pts in the PROTECT trial showed lack of decongestion was a predictor of mortality and HF re-hospitalization

Another one by Metra: pubmed.ncbi.nlm.nih.gov/22167320/
Only a minority of patients in the DOSE trial, which used high dose diuretics were free from congestion at 72 hours

nejm.org/doi/full/10.10…
Read 16 tweets
✳️ #TenTweetNephJC ✳️

👉 where we catch you up on the week's #NephJC chat in 10 tweets 

The topic at hand was Plasma Exchange and Vasculitis: the infamous debate of to PLEX or not to PLEX in AAV

Check out this thread to see if you change your mind on this comPLEX topic 👇 Image
What did I miss?

PLEX, with its plausible biological rationale, has been in the center of debate for management of AAV since the 1980s, with several RCTs in favor of PLEX or against it

🔸️An updated meta-analysis which included the PEXIVAS results was discussed
1 tweet methods

✅ updated systematic review & meta-analysis

✅ RCTs of patients with AAV or pauci-immune RPGN receiving PLEX and ≥12mo. follow-up

✅ Outcome measures were at least one of: mortality, ESKD, serious infection, relapse, AE or health-related QoL
Read 10 tweets
✳️ Welcome to #TenTweetNephJC, where we catch you up on the week's #NephJC chat in 10 tweets ✳️

The topic at hand was diuretic resistance, specifically compensatory post-diuretic sodium reabsorption (CPDSR). Let’s walk you through how it all flowed 💧
What did I miss?

We teach medical students that diuretic resistance occurs in large part due to CPDSR. While this has been validated in healthy individuals, does this hold true in patients w/ acute decomp heart failure (ADHF)?
Enter the study in question
pubmed.ncbi.nlm.nih.gov/34529781/
1 tweet methods

✅Single center, prospective, observational study, with a randomized sub-cohort
✅Evaluating mechanisms of diuretic resistance in patients with ADHF on IV loops 💉
✅Supervised urine collection pre and post diuresis
✅Primary outcome = level of CPDSR
Read 10 tweets
This weeks #TenTweetNephJC makes us sad - does taking regular acetaminophen (paracetamol) cause hypertension?

Find out below in this rapid review of the Scottish trial, as we catch up on the #NephJC take on things 👇 Image
What did I miss?

Observational trials suggest that acetaminophen increases BP, but (unlike NSAIDs) the widespread impression remains of a safe first-line therapy for chronic pain. The largest previous RCT had n=33.

Then PATH-BP dropped last month….

pubmed.ncbi.nlm.nih.gov/35130054/
1 Tweet Methods

✔️ Single-centre, double-blind, placebo-controlled, crossover study

✔️ 4g/day acetaminophen (the standard UK dose) 🆚 placebo

✔️ 2 weeks active or placebo ➡️ 2 weeks washout ➡️ 2 weeks on opposite treatment

✔️ Primary outcome = change in 24 hour ambulatory BP
Read 10 tweets
✳️ #TenTweetNephJC ✳️

Did you see in the news that they’ve transplanted a pig kidney into a human and it (sort of) worked?

That was the #NephJC chat last week - for a rapid summary check out the thread👇 Image
What did I miss?

We need more kidneys to transplant, hence the University of Alabama is running xenotransplant research.

Porcine kidney transplantation into humans has been tried before, but this is the first study to report no hyperacute rejection.

pubmed.ncbi.nlm.nih.gov/35049121/
1 tweet methods

✅Family of a 57 y.o. man with brain death gave consent

✅Pig with 6 human genes knocked in & 4 pig genes knocked out

✅Negative crossmatch

✅Descendant underwent induction immunosuppression, bilateral native nephrectomy, & implantation of two porcine kidneys
Read 10 tweets
Join us tomorrow for the launch of a new accredited tweetorial – a case-based program on the assessment and management of patients with IgA #nephropathy (#IgAN). Free CE/#CME for #physicians, #nurses, #pharmacists! Expert author none other than @IgAN_JBarratt. FOLLOW US . . .
. . . and tell your colleagues to join you here on @ckd_ce, your ONLY source for accredited #tweetorials in the #CKD space! #nephtwitter #nephjc @nephondemand @Nephro_Sparks @edgarvlermamd @ChristosArgyrop @goKDIGO @nicklimd @CKJsocial @ERAkidney @kidney_boy @kidneypathology
1) Welcome to our accredited #tweetorial on optimal contemporary mgt of #IgAN. Earn 0.5h CME/CE credit #physicians #nurses #nursepractitioners #physicianassistants by following this thread. I am @IgAN_JBarratt. @MedTweetorials #nephtwitter #nephjc #FOAMed #MedEd Image
Read 56 tweets
First clinical-grade porcine 🐖 kidney xenotransplant using a human decedent model ca. 2022 from @amjtransplant #NephJC #Nephpearls

#VisualAbstract by @NamrataYParikh

👉🏼 pubmed.ncbi.nlm.nih.gov/35049121/ Image
Attitudes to Clinical Pig Kidney Xenotransplantation among Medical Providers and Patients ca. 2020 from @ASNKidney360 #Nephpearls

kidney360.asnjournals.org/content/1/7/657 ImageImage
Paving the Path toward Porcine Organs for Transplantation ca. 2017 from @NEJM #NephJC #Nephpearls

nejm.org/doi/full/10.10… ImageImage
Read 4 tweets
Welcome to #TenTweetNephJC

✳️ 10 tweets to catch-up on the most recent #NephJC ✳️

This week - when is the ideal time to start dialysis in progressive chronic kidney disease?

Later starts lower the burden on patients & use of healthcare resources, but what’s the trade-off?
What did I miss?

Previous observational studies analysing outcomes by eGFR at point of dialysis initiation suffered from immortal time bias, survivor bias, and lead time bias. This trial used clever new statistical methods to avoid these flaws!

bmj.com/content/375/bm…
1 tweet methods

✅ Observational cohort study from 🇸🇪

✅ 10,290 patients with CKD in Swedish registry

✅ Target trial emulation using “cloning, censoring & weighting” method used to avoid biases mentioned above
Read 10 tweets
Return of #TenTweetNephJC

✳️Rapid #NephJC catch-up✳️

Cochrane & KDIGO recommend children with steroid-sensitive nephrotic syndrome (SSNS) take low dose pred during upper resp tract infection (URTI) to ⬇️relapse risk, based on 4 small studies - does this hold up in a big RCT? Image
What did I miss?

We actually covered two studies this week in collaboration with @ipnajc but we can’t do both in #TenTweetNephJC! We’ll focus on the PREDNOS-2 trial.

jamanetwork.com/journals/jamap…
1 tweet methods

✅ 122 centres in UK

✅ Prospective, double-blind, placebo-controlled RCT

✅ Children aged 1-18, with 2 or more SSNS relapses in last year

✅ 6 days low dose pred, or placebo, at start of URTI

✅ Did they get proteinuria +++ or worse over next fortnight?
Read 10 tweets
PREDNOS 2: Evaluation of Daily Low-Dose Prednisolone During URTI to Prevent Relapse in Children w/ Relapsing Steroid-Sensitive Nephrotic Syndrome ca, 2022 from @JAMAPediatrics #NephJC #IPNAJC #Nephpearls

#VisualAbstract by @drM_sudha

jamanetwork.com/journals/jamap…
Low-dose versus conventional-dose prednisolone for nephrotic syndrome relapses: a randomized controlled non-inferiority trial ca. 2022 from @Ped_Neph #NephJC #IPNAJC #Nephpearls

#VisualAbstract by @md_abdulqader83

link.springer.com/article/10.100…
PREDNOS: Sixteen-week versus standard eight-week prednisolone therapy for childhood nephrotic syndrome ca. 2019 from @bmj_latest #NephJC #IPNAJC #Nephpearls

#VisualAbstract by @jbda19

pubmed.ncbi.nlm.nih.gov/31156083/
Read 5 tweets
as we come to the end of the year, let's do a quick recap of the year in review for #NephJC

We discussed 24 topics in 2021, including
14 RCTs
6 observational studies
3 guidelines
1 book club
nephjc.com/news/?category…
New this year was the #NephTrials initiative with @ISNkidneycare with 3 chats on
- Cluster RCTs
- Pragmatic RCTs
- Run in periods
More to come in 2022
nephjc.com/news/tag/nepht…
Read 12 tweets
Reading twitter on a Friday night? You sound like just type of person we are looking for in the Nephrology Social Media Collective (NSMC) Internship.
The NSMC is a free, one-year, remote internship where you will learn how to make infographics, run a #NephJC twitter chat, create #Tweetorials, and record, edit and publish a podcast.
We take applications for only a few weeks in December and early January. Most interns are Nephrology Fellows or early career faculty, but we have had full professors, nurses, residents, a medical student, basic scientists, dietitians, all complete the experience.
Read 6 tweets
1/
Nephrology:
“We will forever argue about validity of equations to convert serum creatinine to eGFR using age, sex etc”

Also nephrology:
“We will make no adjustment for muscle mass when using urinary creatinine within urine ACR”

A #tweetorial on two albuminuria paradoxes 👇
2/
Recap: why use early morning urine ACR?

✅Correlates well with ‘gold standard’ 24hr urine collection (pain to perform)

✅Creatinine in denominator corrects for urine dilution - works when creat excretion constant (but, note some daily variation)

ncbi.nlm.nih.gov/pmc/articles/P…
3/
Albuminuria quantification is useful prognostically (as well as clear diagnostic utility!):
❗️Independent risk factor for CV mortality
❗️ RENAAL showed higher uACR = higher risk of CKD progression in patients with type 2 diabetes

pubmed.ncbi.nlm.nih.gov/15302780/
Read 20 tweets
Clinical Practice Guideline for the Management of Glomerular Diseases ca. 2021 from @goKDIGO #NephJC #Nephpearls
#VisualGraphics by @michaelturk6

Executive Summary pubmed.ncbi.nlm.nih.gov/34556300/
Full Guideline pubmed.ncbi.nlm.nih.gov/34556256/
The spectrum of glomerular diseases from @neilturn #NephJC #Nephpearls

👉 global.oup.com/academic/produ…
Nephrotic range proteinuria does "not always" mean nephrotic syndrome #NephJC #Nephpearls

👉 pubmed.ncbi.nlm.nih.gov/34556256/
Read 4 tweets
New Creatinine- and Cystatin C–Based Equations to Estimate GFR without Race ca. 2021 from @NEJM #NephJC #Nephpearls
#VisualAbstract by @MdYoshinosuke

nejm.org/doi/full/10.10… ImageImage
A Unifying Approach for GFR Estimation: Recommendations of the @nkf @ASNKidney Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease ca. 2021 from @JASN_News #NephJC #Nephpearls

jasn.asnjournals.org/content/early/… ImageImage
Nice table comparing the different equations used to estimate kidney function #NephJC #Nephpearls
Credit: @michaelturk6 and @nefron1310 Image
Read 5 tweets
Next up is @doc_faubel again for a lit review in AKI. She starts out saying that she will not be able to go over all 68,000 articles in pubmed on the topic. Also nice shout out to #NephJC

#AspenKidney Image
Dose of dialysis Ronco CRRT 20 ml/kg/hr vs 35 vs 45 from 2000 #AspenKidney ImageImage
ATN 20 ml/kg/hr vs 35 CRRT or 3 day/week or 6 d/wk with IHD
She says this is one of the greatest RCT ever done in nephrology.

The study was negative with a bunch of negative outcomes with intensive dialysis #AspenKidney
Read 12 tweets
Next up is Joshua Thurman with a lot review of GN ImageImage
first study is BLISS-LN. Mentions that 2 years of infusions in 448 patients is a big lift. Points out they changed the outcome (probably listens to @NephJC_Podcast (nephjc.com/freelyfiltered…) #AspenKidney
Her is underwelmed with the magnitude of the effect size. He is not sure how to use it. #AspenKidney Image
Read 12 tweets
Efficacy and safety of voclosporin versus placebo for #lupus nephritis (AURORA 1): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial from @TheLancet @BradRovin #NephJC #Nephpearls
#VisualAbstract by @katierizzolo
👉🏼 thelancet.com/journals/lance…
Voclosporin: Hope on the Horizon for #Lupus Nephritis ⁉️ from @KidneyNews February 2021 issue #Nephpearls #NephJC
👉 asn-online.org/publications/k…
AURA-LV: A randomized, controlled double-blind study comparing the efficacy and safety of dose-ranging voclosporin with placebo in achieving remission in patients with active lupus nephritis ca. 2018 from @Kidney_Int @BradRovin #Nephpearls #NephJC
👉🏼 kidney-international.org/article/S0085-…
Read 6 tweets
A Thread.
The Indian Government has increased the gap btw the two doses of #COVID19 vaccination to 3 to 4 months now, ostensibly to improve protection but actually bcos of vaccine stock deficiency. This should NOT apply to Chronic Kidney Disease pts, #Dialysis & Transplant pts.
CKD pts, #dialysis and Transplant pts run a very high risk of morbidity and mortality (4 fold) with #COVID19 infection, much higher than diabetics and pts with heart disease or asthma (1.2 to 2 fold)
nature.com/articles/s4158…
Data from India has also shown high mortality (38%) in dialysis pts. Study by @MayuriTrivedi80 et al
Read 12 tweets
1/
[How] does aminoglycoside hypomagnesemia?

I've long assumed that aminoglycoside's primary toxicities are nephrotoxicity, ototoxicity, and neuromuscular blockade.

we know a little about potential Electrolyte abnormalities

ARE you ready for a #tweetorial?🧵
#medtwitter
2/
First, a question.
Which of the following isn't characteristic of the Electrolyte abnormalities caused by aminoglycosides ? #MedEd
3/
-Aminoglycoside antibiotics are very effective in the treatment of gram‐negative organisms🦠
-The pathogenesis of aminoglycoside‐induced nephrotoxicity is well documented (Tulkens, 1989; Kacew, 1990).
Read 15 tweets

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