The Filtrate

Joel Topf

AC Gomez

Sophia Ambruso

Nayan Arora

Special Guest

Charles Edelstein, MD, PhD Professor, Medicine-Renal Med Diseases/Hypertension

Extra-Special Guest

Michelle Rheault, MD Professor of Pediatrics, University of Minnesota

Editing by

Simon and Joel Topf

The Kidney Connection written and performed by by Tim Yau

Show Notes

KDIGO ADPKD Guidelines:

Website

Guideline PDF

Executive Summary PDF

NephJC coverage

Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP)

Hy’s Law (Wikipedia) has three components:

ALT or AST by 3-fold or greater above the upper limit of normal

And total serum bilirubin of greater than 2× the upper limit of normal, without findings of cholestasis (defined as serum alkaline phosphatase activity less than 2× the upper limit of normal)

And no other reason can be found to explain the combination of increased aminotransferase and serum total bilirubin, such as viral hepatitis, alcohol abuse, ischemia, preexisting liver disease, or another drug capable of causing the observed injury

Meeting this definition yields a very high risk of fulminant kidney failure (76% in one series)

Clinical Pattern of Tolvaptan-Associated Liver Injury in Subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database (PubMed) Two of 957 patients on tolvaptan met Hy’s law criteria. None had fulminant kidney failure.

Effects of Hydrochlorothiazide and Metformin on Aquaresis and Nephroprotection by a Vasopressin V2 Receptor Antagonist in ADPKD: A Randomized Crossover Trial (PubMed) Patients had a baseline urine volume on tolvaptan of 6.9 L/24 h. Urine volume decreased to 5.1 L/24 h with hydrochlorothiazide and to 5.4 L/24 h on metformin.

TEMPO 3:4 Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease (NEJM)

Reprise Trial Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease ( NEJM | NephJC )

Unified ultrasonographic diagnostic criteria for polycystic kidney disease by Edelstein in JASN (PubMed)

Tolvaptan and Kidney Function Decline in Older Individuals With Autosomal Dominant Polycystic Kidney Disease: A Pooled Analysis of Randomized Clinical Trials and Observational Studies (PubMed)

Charles’ draft choice Recommendation 4.1.1.1: We recommend initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ‡25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease (1B).

Sophia’s draft choice Recommendation 1.4.2.1: We recommend employing the Mayo Imaging Classi cation (MIC) to predict future decline in kidney function and the timing of kidney failure (1B).

Progression to kidney failure in ADPKD: the PROPKD score underestimates the risk assessed by the Mayo imaging classification (Frontiers of Science)

AC’s draft choice Recommendation 9.2.1: We recommend targeting BP to ≤ 50th percentile for age, sex, and height or ≤ 110/70 mm Hg in adolescents in the setting of ADPKD and high BP (1D).

HALT-PKD Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease (NEJM)

Nayan’s draft choice Recommendation 6.1.2: We recommend screening for ICA in people with ADPKD and a personal history of SAH or a positive family history of ICA, SAH, or unexplained sudden death in those eligible for treatment and who have a reasonable life expectancy (1D).

Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease (CJASN)

Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms (PubMed) Clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms, whereas coiling is associated with lower morbidity and mortality and a better postoperative course.

Joel’s editorial pick Recommendation 6.1.1: We recommend informing adults with ADPKD about the increased risk for intracranial aneurysms (ICAs) and subarachnoid hemorrhage (1C).

Joel’s first draft pick The bring out your dead pick:

Recommendation 4.3.1: We recommend not using mammalian target of rapamycin (mTOR) inhibitors to slow kidney disease progression in people with ADPKD (1C).

Recommendation 4.4.1: We suggest not using statins specfiically to slow kidney disease progression in people with ADPKD (2D).

Recommendation 4.5.1: We recommend not using metformin specifically to slow the rate of disease progression in people with ADPKD who do not have diabetes (1B).

Recommendation 4.6.1: We suggest that somatostatin analogues should not be prescribed for the sole purpose of decreasing eGFR decline in people with ADPKD (2B).

Perfect match: mTOR inhibitors and tuberous sclerosis complex (Orphanet Journal of Rare Diseases)

Navitor Pharmaceuticals Announces Janssen Has Acquired Anakuria Therapeutics, Inc. (BioSpace) This is press release about acquiring the mTor1 inhibitor.

Joel’s second draft pick Recommendation 4.2.1.1: We suggest adapting water intake, spread throughout the day, to achieve at least 2–3 liters of water intake per day in people with ADPKD and an eGFR ≥ 30 ml/min per 1.73 m2 without contraindications to excreting a solute load (2D).

Nayan’s bonus draft Practice Point 4.7.1: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) should not be used to slow eGFR decline in people with ADPKD.

Open-Label, Randomized, Controlled, Crossover Trial on the Effect of Dapagliflozin in Patients With ADPKD Receiving Tolvaptan (KIReports)

SMART Trial of GLP-1ra in non-diabetics: Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial (PubMed)

Tubular Secretions

Nayan: Landman on Paramount Plus (IMDB)

Sophia: Pass

Nayan: steps in with The Pitt on HBO (Wikipedia)

Charles: The White Lotus, Yellowstone 1923, Poirot (IMDB)

AC: The Pitt

Michael Crichton’s Estate Sends The Pitt to the Courtroom (Vulture)

Joel: I Must Betray you by Ruta Sepetys (Amazon)

The Filtered Fragments (OG Filtrate)

Joel Topf

Jennie Lin

Swapnil Hiremath

Special Guest

Brad Rovin GN God and second author from The Ohio State

Koyal Jain GN Specialist from UNC

Alfred Kim Rheumatologist from Washington University

Editing by

Simon Topf and Nayan Arora

The Kidney Connection written and performed by by Tim Yau

Show Notes

Joel’s monologue One of the most surprising facts of nephrology is that despite conventional wisdom that lupus nephritis is an antibody mediated disease, that over a decade ago, the LUNAR investigtors were unable to find a significant benefit when rituximab was added to conventional therapy. And this was after the equally negative phase 2 trial of rituximab, EXPLORER.

In fact, despite this finding rituximab has been able to burough its way into treatment of many nephrologists and rheumatologists as well as the KDIGO guidelines where it is suggested for patients with persistent disease activity or inadequate response to initial standard-of-care therapy.

This long conflict is now coming to an end. Obinutuzumab, a newer, better monoclonal antibody targeting the same CD20 that we grew to love with rituximab, but it has a number of advantages.

One. It is humanized antibody rather than a chimeric mouse-human antibody

Two. It’s cytotoxicity is not complement dependent an particular advantage if you want to deploy it ina disease where hypocomplementemia is a disease characteristic

Three, and most importantly, it causes stronger and deeper b-cell depletion than rituximab. Better B-cell depletion in the blood and tissue.

And this brings us to tonight’s topic, we had already seen the phase two results of obinutuzumab which, unlike EXPLORER, were positive, we will look at the phase three  regency trial. This makes the third novel lupus nephritis drug in the last 4 years. We continue to remake glomerular nephritis.

LUNAR: Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study Pubmed

EXPLORER: Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial Pubmed

REGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis NEJM | NephJC

NOBILITY: B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial Annals of Rheumatic Disease

Comparison of intravenous and subcutaneous exposure supporting dose selection of subcutaneous belimumab systemic lupus erythematosus Phase 3 program PubMed Central

Class 5 lupus nephritis is slow to respond Long-term Use of Voclosporin in Patients with Class V Lupus Nephritis: Results from the AURORA 2 Continuation Study ACR Meeting abstract

Tubular Secretions

Swap: Young Adult novel I Must Betray You by Ruta Sepetys (Amazon)

Koyal: Taekwondo (Wikipedia)

Jennie: these unprecedented times Trump NYT: Administration Freezes $1 Billion for Cornell and $790 Million for Northwestern, Officials Say

Al: Acquired Podcast

Brad: The Feather Thief by Kirk Wallace Johnson (Amazon)

Joel: Paradise on Hulu (Wikipedia)

The Filtrate

Joel Topf

Jordy Cohen

Nayan Arora

Special Guest

Katie Kwon @katiekwonmd.bsky.social

Mariana Murea @MarianaMurea

Editing by

Simon Topf and Joel Topf

Show Notes

NephMadness at AJKDblog.org

The Hemodialysis Region

Vote for your favorites

The Filtrate

Joel Topf

Swapnil Hiremath

AC Gomez

Sopia Ambruso

Nayan Arora

Special Guests

Michelle Rheault, Director, Division of Pediatric Nephrology, Professor of Medicine

Tiffany Caza, Nephropathologist, Scientist and self-described Freely Filtered fan girl

Editing by

Simon Topf and Sophia Ambruso

Show Notes

10. Healthcare Cyberattacks

9. ApoE in C3 glomerulonephropathy

8. Workforce woes in Adult and Pediatric Nephrology

7. Hyponatremia correction meta-analysis

6. Microvascular inflammation increases risk of graft loss - in all of its forms

5. Xenotransplantation

4. KDIGO CKD Guidelines

3. Hypertension control trials (ESPRIT, BPROAD)

2. The Renaissance of IgAN: IgAN treatment trials

1. FLOW: GLP-1 RAs in CKD

The Filtrate

Joel Topf

Swapnil Hiremath

AC Gomez

Jordy Cohen

Nayan Arora

Special Guest

Brendon Nuen

Editing by

Simon Topf and Nayan Arora

Show Notes

FINEARTS-HF in NEJM

FINEARTS Kidney outcomes in JACC

FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes in Nature Medicine discussion in NephJC

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

Live Freely Filtered at KidneyWk

Swapnil comes out as a SpiroStan post to NephJC

TOPCAT

TOPCAT primary publication

TOPCAT North American results

TOPCAT funny business explained

AHA/ACC/HFSA Heart Failure Guidelines (PDF)

SGLT2i are 2a

MRA are a 2b

ARBs are a 2b

ARNI are a 2b

Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone

Kansas city cardiomyopathy questionnaire in patients with CKD without a diagnosis of heart failure: https://pubmed.ncbi.nlm.nih.gov/21187260/

GFR slope with steroidal MRAs in HF: https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2635

Why Has it Been Challenging to Modify Kidney Disease Progression in Patients With Heart Failure? (JACC)

Tubular Secretions

Swap: Disclaimer on Apple TV

AC: Duo Lingo Plushy (Amazon)

Nayan: The Puzzle Box

Jordy: Project Hail Mary

Brendon has a podcast, The Kidney Compass with Shikha Wadhwani. And he recommends singer-songwriter, Maggie Rogers (YouTube)

Joel: The Singularity Is Nearer: When We Merge with AI by Ray Kurzweil

Closing music, Tim Yau with The Kidney Connection

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