Freely Filtered, a NephJC Podcast

The Filtrate:

Joel Topf

Swapnil Hiremath

With Special Guest:

Michelle Hladunewich, Nephrologist at the University of Toronto

Mir Melamed, Maternal-Fetal Medicine at the University of Toronto

Editor

Simon Topf

Show Notes

Priscilla Smith’s letter:

Dear Joel and the Freely Filtered team,

I am a long-time fan of your podcast and was looking forward to hearing your recently aired discussion of the Praecis study of sflt1:PlGF use in preeclampsia. Preeclampsia and renal disease in pregnancy are areas that many nephrologists report a lack of knowledge or confidence in discussing and managing. I am a nephrologist who has been co-leading a renal pregnancy clinic in London while writing a PhD on progression of renal disease in pregnancy. I have had the immense privilege of working with experts and key opinion leaders in preeclampsia research both in the UK and internationally. As you know, preeclampsia is a serious and significant condition contributing to global maternal mortality and is also associated with future CKD and CVD risk so is both relevant and important within our professional group.

Sadly, I found myself disappointed by the episode and felt it was a missed opportunity. I appreciate that you had difficulties obtaining appropriate experts to join the discussion, but perhaps it would have been better to delay production. While you all valiantly proceeded to discuss this important study, the topic is complex and there appeared to be a lack of understanding of the surrounding literature and pathogenesis of preeclampsia. Sadly, the maternal medicine expert’s comments at the end of the podcast added little as she seemed determine to negate any benefit from the results despite declaring she had no experience or expertise in the use of these biomarkers.

There are many people who understand the clinical aspects of preeclampsia as well as having direct experience of the use and utility of these biomarkers who would have been able to contribute much to your conversation. I look forward to future discussions of renal disease in pregnancy on your podcast and would be happy to suggest some expert panellists if you ever find yourself stuck.

Kind regards,

Priscilla

Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia (JCI 2003)

sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed)

PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed)

The PRAECIS trial (NephJC | NEJM Evidence)

We had a great NephJC get together. We recorded the whole event and packaged it into a podcast.

Musical entertainment

Tim Yau (@Maximal_Change)

Too Sweet by Hozier

Fairy Tale of New York by written Jem Finer and Shane MacGowan. Hear it performed by the Pogues.

Interview of Tom Mueller

Tom Mueller author of How to Make a Killing

Jade Teakall@jmteakell

Graham Abra@GrahamAbra

Interview of Tom Mueller

Tom Mueller author of How to Make a Killing

Jade Teakall @jmteakell

Graham Abra @GrahamAbra

NephMadness logo reveal

NephJC Kidneys

NephJC blog post

NephJC Manuscript of the Year: Flow accepted by Meg Jardine

Manjula Kurella Tamura, winner of the 2015 NephMadness, oh and author of NEJM manuscripts and subject of a NYT article.

NephJC Visual Abstract of the Year: Corina Teodusiu, creator of the Flozinator logo

NephJC Social Justice Award: ISN petition to the WHO on Kidney Health

Most Engaged Scientist Award: Michelle Rheault

Rookie of the Year: Milagros Flores

MVP: Christina Popa

NephJC Founders Award: Joshua Waitzman

Nathan Hellman Social Media Project of the Year: Edgar Lerma and the ASN Visual Abstract Team

More Music with Tim

Saginaw, Michigan as performed by Johny Cash

Betty, written by Taylor Swift

The Kidney Connection

Freely Filtered Kidney Week Draft

Previous drafts

2021 ASN Kidney Week Draft

2022 ASN Kidney Week Draft

2023 ASN Kidney Week Draft

List of all the simultaneous publications from Kidney Week 2024

Sophia: SMART Trial (Link goes to the new KidneyCompass podcast that interview lead author Hiddo Heerspink

Jordy’s editorial in the European Heart Journal. Link

Josh: APPLAUSE Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy in the NEJM

APPLAUSE results announcement at The World Congress of Neophrology in Buenos Aries

Iptapocan is a factor B inhibition

Jordy: POISE-3 with simultaneous publication in KI

Mentions she wanted to pick KAT-AKI because she worked with Perry Wilson.

Per Nayan, Amit Garg is the Beyonce of Nephrology

Accord Trial (NEJM)

Joel: HSK21541 for Pruritus

Correction link to source (graph)

Nayan: FINEARTS-HF with simultaneous publication in JACC

BARACH-D: Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial (Nature Medicine)

Swapnil comes out as a SpiroStan

TOPCAT funny business

PATHWAY-2 Trial (NephJC coverage)

Swap: K Bath and cardiac arrhythmia with simultaneous publication in Kidney International

CAST: A study that rocked the cardiology world and became the poster child for evidence-based medicine (Link)

Tubular Secretions

Swap: Late breaking and high impact sessions

Nayan: Intro to…

Joel: Student poster on blood pressure technique

Jordy: The Penguin. A couple of mentee posters

Sophie: Tracks her sessions on paper.

Josh: Quiz and Questionaire session with JC Velez, Bea Concepcione, Anna Burgner, Roger Rodby.

The Filtrate:

Jennie Lin

Joel Topf

Josh Waitzman

Swapnil Hiremath

With Special Guests

Pedro Teixeira

Jay Koyner

Editor

Sophia Ambruso

Show Notes

The article: A Randomized Trial of Intravenous Amino Acids for Kidney Protection

NephJC Summary

KDIGO Clinical Practice Guideline for Acute Kidney Injury (PDF)

Steve Coca study Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials (PubMed)

Using Nephrocheck to prevent AKI: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial (PubMed)

Brenner’s Review of protein intake and renal hemodynamics: Dietary Protein Intake and the Progressive Nature of Kidney Disease: — The Role of Hemodynamically Mediated Glomerular Injury in the Pathogenesis of Progressive Glomerular Sclerosis in Aging, Renal Ablation, and Intrinsic Renal Disease (NEJM)

Husain-Syed a look at preoperative renal functional reserve and risk of AKI: Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation (PubMed)

Dana Fuhrman review of renal functional reserve: The Role of Renal Functional Reserve in Predicting Acute Kidney Injury (PubMed)

Use of SGLT2i prevented AKI in the placebo controlled trials. Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals (PubMed)

Assessment of P values for demographic data in randomized controlled trials (PubMed)

Tubular Secretions

Swapnil The Lord of the Rings: Rings of Power Season 2 on Amazon Prime (Wikipedia)

Josh Fortnite (Website)

Pedro CRRT Academy at University of Alabama Birmingham (Website)

Jay Koyner Slow Horses on AppleTV (Wikipedia)

Jennie Linn #KidneyWk Run Club Friday 10/25 at 6:15 am PST Meet in front of Sally’s Fish House ~2 miles. Easy pace (10-12 min/mile) (Strava)

Joel Topf Your Honor on Netflix (Wikipedia)

The draft order:

Sophia Ambruso

Nayan Arora

Swapnil Hiremath

AC Gomez

Joel Topf

Editor

Nayan Arora

Show Notes

Previous drafts:

2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh

2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie

2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan

2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan

2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh

2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, AC

The guideline

The NephJC discussion Part 1 | Part 2

First Round

Sophia’s Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A).

Not Nayan’s Pick 3.7.3: We suggest treating adults with eGFR 20 to 45 ml/min per 1.73 m2 with urine ACR <200 mg/g (<20 mg/mmol) with an SGLT2i (2B).

Nayan’s Pick 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A).

A birdie told me there will not be a Tangri KFRE vs the World debate at Kidney Week

The action points based on absolute risk results:

Practice Point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations.

Practice Point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations.

Practice Point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for kidney replacement therapy (KRT) including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations.

Swap’s Pick 3.15.1.1: In adults aged ‡50 years with eGFR <60 ml/min per 1.73 m2 but not treated with chronic dialysis or kidney transplantation (GFR categories G3a–G5), we recommend treatment with a statin or statin/ezetimibe combination (1A).

AC’s Pick 3.7.2: We recommend treating adults with CKD with an SGLT2i for the following (1A):

eGFR ≥20 ml/min per 1.73 m2 with urine ACR ≥200 mg/g (≥20 mg/mmol), or

heart failure, irrespective of level of albuminuria. (1A)

Joel’s Pick 3.10.1: In people with CKD, consider use of pharmacological treatment with or without dietary intervention to prevent development of acidosis with potential clinical implications (e.g., serum bicarbonate <18 mmol/l in adults).

Practice Point 3.10.2: Monitor treatment for metabolic acidosis to ensure it does not result in serum bicarbonate concentrations exceeding the upper limit of normal and does not adversely affect BP control, serum potassium, or fluid status.

Freely Filtered 061: Bicarb in Transplant with Nav Tangri

Second Round

Joel’s Pick 3.3.1.1: We suggest maintaining a protein intake of 0.8 g/kg body weight/d in adults with CKD G3–G5 (2C).

Practice points related to protein intake:

3.3.1.1: Avoid high protein intake (>1.3 g/kg body weight/d) in adults with CKD at risk of progression.

3.3.1.2: In adults with CKD who are willing and able, and who are at risk of kidney failure, consider prescribing, under close supervision, a very low–protein diet (0.3–0.4 g/kg body weight/d) supplemented with essential amino acids or ketoacid analogs (up to 0.6 g/kg body weight/d).

3.3.1.3: Do not prescribe low- or very low–protein diets in metabolically unstable people with CKD.

AC’s Pick 3.9.1: In adults with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA (1B).

Swapnil’s Pick Practice Point 5.4.1: Initiate dialysis based on a composite assessment of a person’s symptoms, signs, QoL, preferences, level of GFR, and laboratory abnormalities.

IDEAL Trial: A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis NEJM

Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study NephJC

Nayan’s Pick Practice Point 1.1.4.2: Use tests to establish a cause based on resources available (Table 6b).

Sophia’s Pick Practice Point 1.1.1.2: Following incidental detection of elevated urinary albumin-to-creatinine ratio (ACR), hematuria, or low estimated GFR (eGFR), repeat tests to confirm presence of CKD.

Joel’s cystatin C Tweet

The cystatin C guideline recommendation 1.1.2.1: In adults at risk for CKD, we recommend using creatinine-based estimated glomerular filtration rate (eGFRcr). If cystatin C is available, the GFR category should be estimated from the combination of creatinine and cystatin C (creatinine and cystatin C– based estimated glomerular filtration rate [eGFRcr-cys]) (1B).

Nayan’s additional thoughts. He is not a fan of Practice Points 3.6.4 and 3.6.5

Practice Point 3.6.4 Continue ACEi or ARB therapy unless serum creatinine rises by more than 30% within 4 weeks following initiation of treatment or an increase in dose.

and

Practice Point 3.6.5: Consider reducing the dose or discontinuing ACEi or ARB in the setting of either symptomatic hypotension or uncontrolled hyperkalemia despite medical treatment, or to reduce uremic symptoms while treating kidney failure (estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2).

Tubular Secretion

Swap The Murderbot Diaries by Martha Wells

Nayan Searching for Hobey Baker Narrated by David Duchovny

AC Rosie Revere, Engineer

Sophia Bassnectar

How to fix the Apple Music automatically playing when you connect to bluetooth.

Joel The Veil with Elizabeth Moss

The Filtrate:

Joel Topf

Josh Waitzman

With Special Guest:

Brad Rovin (@BradRovin) Chief of nephrology at The Ohio State University Wexner Medical Center, one of the authors of the Nefigard trial.

Koyal Jain (@koyaljainMD) Program director of the GN Fellowship at University of North Carolina

Roger Rodby (@NephRodby) Associate program director of the Rush University Nephrology Fellowship

Editor

Sophia Ambruso

Show Notes

The manuscript (The Lancet | PubMed | NephJC)

The Results of Part A (Kidney Int | PubMed)

Edmund (Ed) Louis memorium by Steve Korbet in KI

Steve Korbet Do not miss this tweet

TESTING Freely Filtered #48 with Sean Barbour

Iptapocan at the World Congress of Nephrology: WCN24-1506 Efficacy And Safety Of Iptacopan In Patients With IgA Nephropathy: Interim Results From The Phase 3 APPLAUSE-IgAN Study

FDA and mandatory post-marketing studies. What happens when the study is negative (or not completed) (UNDARK)

Who should treat lupus nephritis: rheumatologists or nephrologists? (Nature Reviews Nephrology)

Protein and albumin-to-creatinine ratios in random urines accurately predict 24 h protein and albumin loss in patients with kidney disease (PubMed)

MEST Scores in NephJC

Risk scores in IgAN in NephJC

Repeat renal biopsy improves the Oxford classification-based prediction of immunoglobulin A nephropathy outcome (NDT)

Tarpeyo pills 4 mg. Four pills once a day. (WellRx has a picture of the pills)

IgA nephropathy in African Americans: uncommon but possible (PubMed Central)

Aberrantly Glycosylated IgA1 in IgA Nephropathy: What We Know and What We Don’t Know (PubMed Central)

Effectiveness of Mycophenolate Mofetil Among Patients With Progressive IgA Nephropathy (JAMA Network Open)

Tubular Secretions

Joel: Constellation on Apple TV (Wikipedia). Not good. Dune audio books are excellent. (Audible)

Josh: Podcasts about donating a kidney

One Is Enough Podcast (National Kidney Registry)

Donor Diaries (National Kidney Donation Organization)

Roger Iceland (Wikipedia)

Koyal India (Wikipedia)

Brad Fishing in Dubai

The Filtrate:

Joel Topf

Swapnil Hiremath

Josh Waitzman

Nayan Arora

Sophia Ambruso

With Special Guest:

Brendon Neuen Super smart guy and clinical trialist

Vlado Perkovic Lead author of FLOW and friend of NephJC

Editor

Joel Topf

Show Notes

The manuscript (NEJM): Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes

The acronym FLOW from the title: evaluate renal Function with semagLutide Once Weekly (Twitter)

Joel wrote a blog post prior to the FLOW publication to try to set the table: Peeking Inside Schrödinger’s Box

Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter)

Modification of Association of Cystatin C With Kidney and Cardiovascular Outcomes by Obesity (Science Direct)

Semaglutide and Diabetic Retinopathy Risk in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials (PubMed)

The Efficacy and Safety of the Combination Therapy With GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis (Frontiers in Pharmacology)

Statistical considerations for testing multiple endpoints in group sequential or adaptive clinical trials (PubMed)

Proteinuria Thresholds Are Irrational: A Call for Proteinuria Indexing (Nephron Clinical Practice)

Frank Harrel on why the NNT sucks (data methods)

Regulation of Na+/H+ exchanger NHE3 by glucagon-like peptide 1 receptor agonist exendin-4 in renal proximal tubule cells (PubMed)

Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance (PubMed)

Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial (PubMed)

Doctors are like the pyromaniac fireman (PBFluids)

Suggest topics for NephMadness (Twitter)

Design of the COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint study (CONFIDENCE) (PubMed)

Albuminuria-Lowering Effect of Dapagliflozin, Eplerenone, and Their Combination in Patients with Chronic Kidney Disease: A Randomized Crossover Clinical Trial (PubMed)

Spitzer’s involvement in revolutionizing nephrology is part of this lecture I did at the University of Nebraska Diabetes Symposium. (Dropbox: Start on slide 29)

Spitzer Resigns, Citing Personal Failings (New York Times)

Tubular Secretions

Swap: Dumb Money on NetFlix (Wikipedia)

Josh: Hiking Zion National Park (National Park Service)

Sophia: Lost in Space 2018 TV series on NetFlix (Wikipedia)

Nayan: Pelican Hill resort (Website)

Joel: Bodkin

NephJC Summer Book Club: Covenant of Water by Abraham Verghese (Amazon)

The Filtrate:

Joel Topf

Swapnil Hiremath

AC Gomez

Nayan Arora

With Special Guest:

Anuja Java, complement god and pre-eclampsia research (Twitter)

Shannon M. Clark, MD, FACOG, an honest to god, true, maternal-fetal medicine specialist. (Website | Instagram)

Editor

Nayan Arora

Show Notes

CHIP Study from 2015 (NEJM | NephMadness 2015)

CHAP study from 2022 (NEJM | NephJC)

NephMadness 2024 coverage of the diagnosis of preeclampsia

sFlt background: Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta (PubMed)

PlGF background: Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps (PubMed)

The PRAECIS trial (NephJC | NEJM Evidence)

You may just want to listen to Anna Burgner discuss preeclampsia with Kenar Jhaveri and Koyal Jain (GN in Ten) for the NephMadness PodCrawl

Bene Gesserit (Wikipedia)

Pathogenesis of preeclampsia: the genetic component (PubMed)

Tubular Secretions

Swap Slow Horses on Apple TV (Wikipedia)

AC Hidden Figures (Amazon)

Nayan Baseball, little league

Anuja Young Sheldon (Wikipedia)

Joel Dune audiobook (Amazon)

The Filtrate:

Joel Topf

Swapnil Hiremath

Priya Yenebere

Nayan Arora

With Special Guest:

Brendon Neuen Super smart guy and clinical trialist

Michelle Rheault Lead author of DUPLEX and friend of the pod

Show Notes

Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis

NephJC Summary | PubMed | NEJM

KDIGO FSGS Guidelines 2021 (PDF)

Characterization of the Clinical Evidence Supporting Repository Corticotropin Injection for FDA-Approved Indications, A Scoping Review (JAMA Internal Medicine)

DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed)

Vlado Perkovic, mentor and sponsor extradenoire (UNSW Sydney)

Shimer Its a floor wax and a desert topping (TikTok)

SONAR: Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease: a double-blind, randomised, placebo-controlled trial. (NephJC)

Travere Therapeutics Announces FDA Accelerated Approval of FILSPARIᵀᴹ (sparsentan), the First and Only Non-immunosuppressive Therapy for the Reduction of Proteinuria in IgA Nephropathy (Travere press release)

GFR Slope: Chronic vs Total slope: A meta-analysis of GFR slope as a surrogate endpoint for kidney failure (Nature Medicine)

There are dozens of us! Dozens! (Know your Meme)

Brendon’s Neuen’s tweet about total versus chronic slope (X | Twitter)

Julie R. Ingelfinger, deputy editor for the New England Journal of Medicine (Wikipedia)

You know nothing, John Snow (YouTube shorts)

Tubular Secretions

Swapnil Foundation season two on Apple TV Wheel of Time season two Amazon Prime

Brendon Andor

Priya Poverty, by America Mattew Desmond

Nayan The Armor of Light: A Novel by Ken Follett

Michelle Lessons in Chemistry: A Novel by Bonnie Garmus

The Filtrate:

Joel Topf

Swapnil Hiremath

Jordy Cohen

AC Gomez

With Special Guest:

Tim Anderson @TimAndersonMD

Editor:

Priya Yenebere

Show Notes

Clinical Outcomes of Intensive Inpatient Blood Pressure Management in Hospitalized Older Adults

NephJC Summary | PubMed | JAMA Internal Medicine

The Jordy AC collab: An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback (PubMed)

Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge (PubMed)

Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008 to 2018 (PubMed)

Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial (JAMA Guide to Statistics and Methods)

Tubular secretions

Swap The Dispatcher by John Scalzi (Wikipedia)

AC A Heart that Works by Rob Delaney (NYT Review)

Tim Demon Copperhead by Barbara Kingsolver (Amazon)

Jordy The Anthropocene Reviewed: Essays on a Human-Centered Planet (Amazon)

Joel The Dolomites for hiking n Northern Italy

Animal House Region

NephMadness description by Tiffany Truong

Editorial by Kelly Hyndman @DrKeeksPhD They May Look Cute, But Are All Animals Sweet?

The Filtrate:

Joel Topf

Swapnil Hiremath

Sophia Ambruso

Josh Waitzman

With Special Guest:

Kelly Hyndman

Editor:

Sophia Ambruso

Show Notes

Animal House 2018 with Mark Zeidel, MD (AJKDblog)

Animal House 2021 with Kelly Hyndman (AJKDBlog)

Animal House 2022 with Kelly Hyndman (AJKDBlog)

Mount Desert Island Summer Junket (Website)

First person account go a Gila Monster bite (YouTube)

Looks like Gila Hank, the gun toting mascot of Eastern Arizona College has been replaced by a non-gun toting Gila monster cowboy. Old logo (Reddit) | New logo (Gila Valley Central Newspaper)

Discovery, characterization, and clinical development of the glucagon-like peptides (Drucker JCI 2017)

The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease (Rossing NDT 2023)

Semaglutide 1.0 mg demonstrates 24% reduction in the risk of kidney disease-related events in people with type 2 diabetes and chronic kidney disease in the FLOW trial (Novo Nordisk)

King Gizzard & The Lizard Wizard - Gila Monster (YouTube)

Eastern Arizona Campus Store

Tubular Secretions

Swap: Three Body Problem (Wikipedia)

Josh: Animal Crossing (Nintendo)

Sophie: Pyelonephritis in inflammatory bowel disease. Is this a thing?

Joel: Maggie Moore(s) (Wikipedia)