The Filtrate:

Joel Topf

Swapnil Hiremath

Nayan Arora

Priya Yenebere

Special Guests:

Todd Miano, PharmD, PhD @Miano81 Assistant Professor of Epidemiology, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine.

Show Notes:

Early Pip/Tazo article showing nephrotoxicity. Covered by NephJC

Linazolid vs Vanco RCT showing excess AKI with Vanco. Yes Vance is a lot less toxic than it was in the Mississippi mud days but your attending telling you it is no longer nephrotoxic is wrong. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study and Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis.

Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum Creatinine

Vancomycin-Associated Cast Nephropathy: Reality or Fantasy?

Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort. Learn about it her: A multibiomarker-based outcome risk stratification model for adult septic shock*

Cystatin C in acute kidney injury

Changing Definitions of Sepsis

Proposed new definitions of AKI incorporating biomarkers: Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference. A Consensus Statement in JAMA Network Open

Applications of propensity score methods in observational comparative effectiveness and safety research: where have we come and where should we go?

The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study

Protective effect of piperacillin against nephrotoxicity of cephaloridine and gentamicin in animals

PulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam by Josh Farkas

Sharp Objects on Good Reads

Bandon Dunes

The Ocean Course at Kiawah Island Golf Resort

Be Real follow me: BeRe.al/kidney_boy

SNL spoof of BeReal

The Filtrate:

Joel Topf

Swapnil Hiremath

Jennie Lin

Special Guests:

Priya Yenebere @PriRenalAKI Transplant nephrologist at Indiana University School of Medicine. She is a current NSMC Intern.

J Pedro Teixeira @NephCrit_NM ICU Nephrologist at the University of New Mexico.

Editor: Priya Yenebere

Show Notes:

Critical Care Nephrology Critical Care Nephrology: Core Curriculum 2020 by Benjamin R Griffin, Kathleen D Liu, and J Pedro Teixeira.

Critical Care Rheumatology Dual-Trained Rheumatologists Take Multidisciplinary Approach to Their Patients

Med-Peds to Nephrology

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock by Emanuel Rivers

ProMISe: Trial of Early, Goal-Directed Resuscitation for Septic Shock

ARISE: Goal-Directed Resuscitation for Patients with Early Septic Shock

ProCESS: A Randomized Trial of Protocol-Based Care for Early Septic ShockThe Filtrate:

Rinaldo Bellomo and micro circulatory disorders as cause of AKI in sepsis. Septic acute kidney injury: new concepts

Comparison of Two Fluid-Management Strategies in Acute Lung Injury (FACTT) The negative trial we accept as a positive trial because of the secondary outcomes.

The prime minister of Finland was caught on the dance floor. This is a bad thing? (NY Times)

Deferred Consent: A New Approach for Resuscitation Research on Comatose Patients

Lactate conversion MediCalc

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters

Critical Care Reviews Podcast: CLASSIC Trial Results Presentation

What is the most George Constanza-esque reason you broke up with someone? (reddit)

Bonferroni correction

The Importance of Fluid Management in Acute Lung Injury Secondary to Septic Shock

Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery in the NEJM. RELIEF, NephJC discussion

Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension: A Randomized Clinical Trial in JAMA

FEAST Trial: Mortality after Fluid Bolus in African Children with Severe Infection

Rings of Power on Amazon Prime

Why the Hobbit trilogy sucked

Industry on HBO

Sandman 2022 on Netflix

Where did Liverpool FC go wrong with the 2021/2022 Premier League? (Quora)

CRRT Academy at University of Alabama with

2020 Robert G. Narins Award Recipient: Ashita Tolwani, MD, MS (YouTube)

Life as a Nephrologist podcast on CritCare Nephrology

Continuous KRT: A Contemporary Review by J. Pedro Teixeira, Javier A. Neyra and Ashita Tolwani

University of New Mexico Nephrology Program. Apply to their fellowship.

The Pledge Drive is over, but you can always support NephJC. NephJC is a 501(3)c registered non-profit and all donations are tax deductible in the US.

The Filtrate:

Joel Topf

Swapnil Hiremath

Josh Waitzman

Sophia Ambruso

Special Guests:

Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA. His Google Schoolar page is better than yours.

And returning for her third time (why sdo we keep inviting her back?)
Sadiya Khan @heartDocSadiya Assistant Professor of Medicine (Cardiology) and Preventative Medicine at Northwestern Feinberg School of Medicine. Link

Editor: Sophia Ambruso

Donate to NephJC

Get your Freely Filtered Mug by becoming a Freely Filtered Fan, all proceeds go to NephJC. All donations are tax deductible in the U.S.

http://www.nephjc.com/new-products/freely-filtered-fan

If you want to support NephJC to a different tune than $200, take a look at the NephJC September Pledge Drive page.

Show Notes:

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure says:

Restricting dietary sodium is a common nonpharmacological treatment for patients with HF symptomatic with congestion, but specific recommendations have been based on low-quality evidence. Concerns about the quality of data regarding clinical benefits or harm of sodium restriction in patients with HF include the lack of current pharmacological therapy, small samples without sufficient racial and ethnic diversity, questions about the correct threshold for clinical benefit, uncertainty about which subgroups benefit most from sodium restriction, and serious questions about the validity of several RCTs in this area. However, there are promising pilot trials of sodium restriction in patients with HF. The AHA currently recommends a reduction of sodium intake to <2300 mg/d for general cardiovascular health promotion; however, there are no trials to support this level of restriction in patients with HF. Sodium restriction can result in poor dietary quality with inadequate macronutrient and micronutrient intake. Nutritional inadequacies have been associated with clinical instability, but routine supplementation of oral iron, thiamine, zinc, vitamin D, or multivitamins has not proven beneficial. The DASH diet is rich in antioxidants and potassium, can achieve sodium restriction without compromising nutritional adequacy when accompanied by dietary counseling, and may be associated with reduced hospitalizations for HF.

This is 2a Class of Recommendation (moderate strength) with a C-LoD level of evidence (Limited data).

Study acronym: the Study Of Dietary Intervention Under 100 Milimoles in Heart Failure.

100 mmol of sodium is 2300 mg

Meta analysis of high versus low sodium diet pulled from Heart due to duplicated and missing data. Retraction Watch.

65 mmol of sodium is 1500 mg

The trial design papers: Design and Region-Specific Adaptation of the Dietary Intervention Used in the SODIUM-HF Trial: A Multicentre Study and Rationale and design of the Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF)

3-day food diaries underestimate sodium intake vs 24 hour urine - and this is worse for patients on loop diuretics: Evaluation of 2 methods for sodium intake assessment in cardiac patients with and without heart failure: the confounding effect of loop diuretics

PREDIMED trial of Mediterranean diet: retracted, republished, still trusted?

DASH Diet trial where they gave food to the participants Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet

Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry

Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art Review

Development and evaluation of the Seattle Angina questionnaire: A new functional status measure for coronary artery disease

Cardiologist Sues Epic Over Copyright Infringement

6-minute walking test: a useful tool in the management of heart failure patients

Frank Harrell on Statistical Errors in the Medical Literature

ANCOVA versus change from baseline: more power in randomized studies, more bias in nonrandomized studies

A-HeFT: Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure

TOPCAT: Spironolactone for Heart Failure with Preserved Ejection Fraction

SSaSS: Effect of Salt Substitution on Cardiovascular Events and Death

Mini Cooper SE Electric hardtop 2 door

Taylor Swift can't stop emitting CO2 with her private plane.

The Captain (miniseries)

Nope.

The Mystery of Why Some People Don’t Get Covid

For All Mankind (TV series)

The Filtrate:

Joel Topf

Swapnil Hiremath

Josh Waitzman

Jordy Cohen

Special Guest:

Sean Barbour. Clinical Associate Professor, Division of Nephrology, University of British Columbia Chair, BC Glomerulonephritis Committee and Network, BC Renal

Editor:

Joel Topf

Show Notes:

NephJC Summary of TESTING: Re-TESTING Steroids for IgA Nephropathy (have you ever noticed how good the titles for the NephJC summaries are?)

TESTING in JAMA

STOP-IgA NephJC Summary: Don't just do something, stand there. Another great title, this one from from a long time ago.

The British Columbia GN network really owes its existence to TESTING: An overview of the British Columbia Glomerulonephritis network and registry: integrating knowledge generation and translation within a single framework (PubMed)

Dunning–Kruger effect Wikipedia

Prior Art for steroids in IgA nephropathy:

Italian study: Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy

Another, earlier, Italian study: Corticosteroids in IgA nephropathy: a randomised controlled trial

Chinese study: Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial

Original TESTING publication from 2017, also in JAMA. Oh, and we covered that in NephJC too, IgA Nephropathy: Testing Steroids Again.

NephJC also talked about Sean Barbour’s risk score for IgA Nephropathy: Summary | Freely Filtered Podcast episode 5

A Controlled Trial of Fish Oil in IgA Nephropathy in the NEJM!

Stevens-Johnson Syndrome. “When to see a doctor Stevens-Johnson syndrome requires immediate medical attention. Seek emergency medical care if you experience signs and symptoms of this condition.”

Change in Albuminuria and GFR as End Points for Clinical Trials in Early Stages of CKD: A Scientific Workshop Sponsored by the National Kidney Foundation in Collaboration With the US Food and Drug Administration and European Medicines Agency (PubMed)

Adaptive Trials in NephMadness 2016 with Selection Committee Member, Perry Wilson!

Treif

Geographic Differences in Genetic Susceptibility to IgA Nephropathy: GWAS Replication Study and Geospatial Risk Analysis

The MEST score provides earlier risk prediction in lgA nephropathy

DAPA-IgA: A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy

Swap and Josh fight about SGLT2i in IgA Nephropathy

Significance of serum galactose deficient IgA1 as a potential biomarker for IgA nephropathy: A case control study (PubMed)

FDA approves first drug to decrease urine protein in IgA nephropathy, a rare kidney disease. FDA has granted accelerated approval for  budesonide delayed release capsules to reduce proteinuria in adults with primary IgA nephropathy at risk of rapid disease progression. It has not been established whether budesonide delayed release capsules slow kidney function decline in patients with IgA nephropathy.

Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial (Lancet)

Omicron in Ontario.

Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD by Swap

Star Trek: Strange New Worlds

Origins of Renal Physiology: Fellows 2022

Medical Students: Kidney TREKS

Application of the International IgA Nephropathy Prediction Tool one or two years post-biopsy (Kidney International)

The Triple Crown in Virginia

The Filtrate:

Joel Topf

Nayan Arora

Sophia Ambruso

Swapnil Hiremath

Josh Waitzman

Special Guest:

Natalie Bello Director of Hypertension Research at Cedars Sinai

Editor:

Nayan Arora

Show Notes:

NephJC summary of CHAP

CHiPS TV show

CHIPS study: Less-Tight versus Tight Control of Hypertension in Pregnancy

Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines (Pubmed)

SFLT in preeclampsia from where else but NephMadness and here.

Aspirin Use to Prevent Preeclampsia and Related Morbidity and MortalityUS Preventive Services Task Force Recommendation Statement (JAMA)

The NNT for aspirin in pregnancy is like a relationship on Facebook, it’s complicated.

Astrologic signs as predictor of aspirin effectiveness in Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (Pubmed)

ACOG revises the guidelines on hypertension: Clinical Guidance for the Integration of the Findings of the Chronic Hypertension and Pregnancy (CHAP) Study

Meta-analysis showing treating blood pressure in pregnancy didn’t help. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy.

The Filtrate:

Joel Topf

Nayan Arora

Sophia Ambruso

Swapnil Hiremath

Special Guest:

Jade Teakall

Jeff Perl, Great Twitter handle, PD_Perls

Editor:

Joel Topf

Show Notes:

ISPD 2022 Peritonitis Guidelines

NephJC Discussion

Dimitrios Oreopoulos obituary in JASN.

Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis

The draft board: Google Doc

The PROMPT Study showing delayed peritonitis treatment increases the risk of treatment failure: The Relationship Between Presentation and the Time of Initial Administration of Antibiotics With Outcomes of Peritonitis in Peritoneal Dialysis Patients: The PROMPT Study

Embedded PD catheters: Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters

Nikhil Shah asking questions about fungal prophylaxis

Question 1

Question 2

Icodextrin antibiotic compatibility: Stability and compatibility of antibiotics in peritoneal dialysis solutions or in Tweet Form.

Nikhil Shah on having antibiotics at home

Tweet thread about the things we do for little reason regarding getting people listed for transplant.

Regarding the trend in duration of antibiotics: Duration of Antibiotic Therapy: Shorter Is Better

‘Spelling the Dream’ Review: Netflix’s Inspiring Spelling Bee Doc Is an Unexpected Rallying Cry

ABC Kidney

Home Dialysis University was May 1, 2

The Grand Canyon, second largest hole in the ground.

The Filtrate:

Joel Topf

Joshua Waitzman

Nayan Arora

Jennie Lin

Sophia Ambruso

Special Guest:

Paul A Welling

Editor:

Sophia Ambruso

Show Notes:

NephJC Summary on SSaSS

Paul Welling’s tweetorial on the potassium switch

The 2016 Canadian Hypertension guidelines were the first to suggest adding potassium: Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension

Swapnil’s Potassium Trial: Diet or additional supplement to increase potassium intake: protocol for an adaptive clinical trial

When Food Firms Cut The Salt, What Do They Put In Instead? From NPR.

Effect of increased potassium 🍌 intake on cardiovascular risk factors and disease: systematic review and meta-analyses

Effect of lower sodium🧂 intake on health: systematic review and meta-analyses

Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study

FDA Issues Final Guidance Regarding Use of an Alternate Name for Potassium Chloride in Food Labeling

David Ellison and Paul Welling’s reviewing the NEJM: Insights into Salt Handling and Blood Pressure

NephTrials on Cluster Randomized Trials: http://www.nephjc.com/news/clusterct

Nu-Salt (KCl) 3 oz for $4.97 at Amazon (no afiliate link because we don’t have our act together)

Salt for Life looks like it is 75% KCl 25% NaCl and it is 11.99 for 10.5 oz at Amazon (see above disclaimer)

Bridgerton, only 8 episodes for Season 2

Inhibition of nonalcoholic fatty liver disease in mice by selective inhibition of mTORC1: The Paper | The Tweet

Kansas wins March Madness

Work in Josh’s lab. Get in touch: [email protected]

Open Educational Resources (OER)

NKF Spring Clinical Meeting 2022

Little Podocye

The Filtrate:

Joel Topf

Joshua Waitzman

Nayan Arora

Jordy Cohen

Special Guest:

Josh Mezrich

Editor:

Nayan Arora

Show Notes:

When Death Becomes Life: Notes from a Transplant Surgeon. Amazon

Am J Transplant 2022 Jan 20. doi: 10.1111/ajt.16930. PMID: 35049121

Coverage on NephJC

First transplant of a pig into a human. NYU transplant.

Keith Reemtsma’s experience with chimpanzees transplantation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1408776/?page=1

Infection of human cells by an endogenous retrovirus of pigs

United Therapeutics page on xenokidney.

Article by Starzl on the early days of kidney transplant, including David Humes experiment grafting kidneys to the arms and grafts of patients. The Early Days of Transplantation

Patient in Groundbreaking Heart Transplant Dies

Heterotopic heart transplantation: where do we stand?

Denton Cooley and the first artificial heart transplant

For the First Time in North America, a Woman Gives Birth After Uterus Transplant From a Deceased Donor

Blacksburg company raised genetically modified pig for first heart transplant into human

Christiaan Barnard and the first human-to-human heart transplant

Making The Impossible Possible: A Conversation With Martine Rothblatt. The founder of United Therapeutics and SiriusXM

Paige Porrett, M.D., Ph.D. first author

Jayme Locke, M.D., MPH senior author

Louise Penny author page

The Four Questions

Chutzpod!

Joshua Malina, not the new cantor at Temple Israel.

Primitive Technology YouTube Channel

The Filtrate:

Joel Topf

Joshua Waitzman

Nayan Arora

Sophia Ambruso

Jordy Cohen

Special Guest:

Kelly Hyndman

Editor:

Joel Topf

PodCrawl

Monday, March 14: The Curbsiders 

An Internal Medicine Podcast…for the Internist. This episode will focus on the Cardiorenal region with Game Maker, Joel Topf @Kidney_Boy, and Selection Committee Member, Sadiya Khan @HeartDocSadiya. 

Listen on Apple or Spotify

Tuesday, March 15: The Drs. Washington

The Drs. Washington are three sister physicians who discuss their story and the stories of minority physicians, tips for students interested in careers in medicine, and health-related topics. In this episode, Katie Rizzolo @katierizzolo and Dinushika Mohottige @DMohottige discuss social and physical determinants of health as well as governmental and institutional initiatives that affect health inequities in nephrology.Listen on Apple or Spotify

Wednesday, March 16: The Cribsiders

On this pediatric podcast, go deep into the Neonatal AKI bracket with the writer, Michelle Starr @mcstarr1. 

Listen on Apple or Spotify

Thursday, March 17: Up My Nursing Game

Up My Nursing Game is an educational nursing podcast that uses expert interviews to address common nursing questions and pitfalls. It offers free CE credits through VCU Health. This episode featuring Bourne Auguste @bourneauguste and Daniel Weiner @DanTheKidneyMan will focus on blood pressure and Dialysis. 

Listen on Apple or Spotify

Friday, March 18: Best Science (BS) Medicine

The Best Science Medicine podcast is all about helping primary care clinicians incorporate the best available evidence into their practice in order to help facilitate shared decision-making. In this episode, Game Makers Samira Farouk @ssfarouk and Matthew Sparks @Nephro_Sparks discuss the tricky issue of albuminuria – who to monitor, what to monitor, and who to treat. They spend a lot of time dribbling and end up deciding that nothing is a slam dunk, so stay until the end for a real buzzer beater.

Listen on Apple or Spotify

Saturday, March 19: Freely Filtered

The Filtrate break down the Animal House region with Selection Committee Member Kelly Hyndman @DrKeeksPhD.

Listen on Apple or Spotify

Show Notes:

Kelly Hyndman is an Assistant Professor of Medicine in the Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, at the University of Alabama at Birmingham. She has trained both in comparative physiology and kidney physiology labs and is currently a principal investigator of a basic science lab with research interests in novel mechanisms of fluid-electrolyte balance.

From Fish to Philosopher by Homer Smith. Review from 1954 in JAMA.

#BlueRibbonFail

Marine Iguana Visual Abstract by Sophie

The Octonauts

The Oregon Trail

CRIC Study

Animal House 2022 blog post by Tiffany Truong

Giraffes sleep 4.6 hours a day. Behavioural sleep in the giraffe (Giraffa camelopardalis) in a zoological garden

Tobias Wang

Peter Bie

Gimli the Corgi Giraffe

ManBearPig from South Park

Mike Tyson

Emus, not mammels

Climate Change Threats on Black Bears in California

As Winter Warms, Bears Can’t Sleep. And They’re Getting Into Trouble.

Fat Bear Week has a champion: All hail 480 Otis

Stillsuit in Dune

Freely Filtered 042: Nephrin Antibodies Cause Minimal Change Disease. Wait...What?

A molecular mechanism explaining albuminuria in kidney disease

American Heart Association Hypertension Podcast with Swapnil Hiremath and Carolyn Thomas

Link to all the AHA podcasts

The Trojan horse Affair podcast

Curbsiders #321 Hypertension FAQ with Jordy Cohen

The Alpinist

The Filtrate:

Joel Topf

Jennie Lin

Joshua Waitzman

Nayan Arora

Sophia Ambruso

Special Guest:

Astrid Weins (@AstridWeins) renal pathologist at the Brigham and Woman’s Hospital and Harvard Medical School

Editor:

Nayan Aurora

Show Notes:

Summary of minimal change disease according to the orthodoxy: Light microscopy of renal biopsy specimens from patients with MCD shows minimal to no change; however, electron microscopy reveals the effacement of podocyte foot processes. To add to the conundrum, immunofluorescent staining of biopsy specimens is negative, and no immune complexes are evident.

Minimal change disease and idiopathic FSGS: manifestations of the same disease

New Views of the Glomerulus: Advanced Microscopy for Advanced Diagnosis

Imaging of the Porous Ultrastructure of the Glomerular Epithelial Filtration Slit

Autoantibodies against podocytic UCHL1 are associated with idiopathic nephrotic syndrome relapses and induce proteinuria in mice

Fishing Expedition

Koch's postulates

Measles in the Nephrotic Syndrome

NEPTUNE: NEPhrotic syndrome sTUdy NEtwork

Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation

Most of these patients have a homozygous truncating mutation (Fin-major mutation) in the nephrin gene (NPHS1), leading to total absence of the major podocyte protein, nephrin. After RTx, these patients develop anti-nephrin antibodies resulting in nephrotic range proteinuria.

Nephrotic syndrome relapse in a boy with COVID-19

Minimal Change Disease After First Dose of Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Review of Minimal Change Disease Related to COVID-19 Vaccine

Dr. Laurence Beck and the discovery of Phospholipase A2 Receptor as Target Antigen in Idiopathic Membranous Nephropathy as published in the NEJM.

Cheer Season 2 now on Netflix

Cloud Cuckoo Land: A Novel by Anthony Doerr

Winter Surfing in Massachusetts?!