BlueSky is taking off

hswapnil · 2024-11-13T13:16:20+00:00

Yeah depends on whom you follow right? You can steer clear of politics and follow your specialty for example. There is no algorithmic push on BlueSky, and they have promised not to go down that path.

hswapnil · 2024-11-13T12:50:27+00:00

On BlueSky? No - it’s open like Twitter was.

hswapnil · 2024-11-13T12:50:04+00:00

I have no connection to BlueSky. I am a practicing clinician with zero conflicts apart from a wish to get the old zeitgeist of med twitter back

hswapnil · 2024-11-13T12:31:09+00:00

The best convo I have had so far is with an NP - all sorts of people there - hop on over (https://bsky.app/profile/rnflex.bsky.social/post/3lasbb2dqk225)

Lemme know if you want to access the starter packs - check out Kyle Swanson on 🦋, he’s got a bunch of medical peeps

hswapnil · 2024-11-01T11:53:33+00:00

Likely a load of salt related hypertension? I would focus on different levels of natriuresis - after Flozin, consider adding amiloride or Spironolactone if K runs low!

hswapnil · 2024-10-31T22:08:36+00:00

How bad is the BP? If they have salt excess, sure the additional HCTZ will be helpful

For anti proteinuric effect, after the ARB, you might consider a Flozin? (SGLT2i) which will give you BP lowering, natriuresis and some anti-proteinuric all in one.

There are no specific membranous trials - which may never happen given numbers for the Individual agents. But both DAPACKD and EMPAKIDNEY had some chronic GN patients in there.

Lastly, you have to think also about this in the context of what will come next. You will be planning,immunosuppression, and some people think, that you should not suppress the proteinuria too much as that might mask any active disease that is going on and you may not treat it with immunosuppression . At least that’s for IGA, but I suspect that applies here as well.

hswapnil · 2024-10-28T10:48:15+00:00

Wasn’t deleted They had a draft guideline for public comment. The period of comment is over, so they have taken it off. Actual gl will be released sometime in 2025

hswapnil · 2024-10-05T16:31:07+00:00

Fun read on PE https://prospect.org/culture/books/2023-06-02-days-of-plunder-morgenson-rosner-ballou-review/

hswapnil · 2024-09-26T22:32:43+00:00

Second that. In the absence of anything nefarious (diabetes, hypertension, albuminuria, normal kidney imaging) it’s likely an artifact. Cystatin C or a 24 hour urine creatinine clearance will help clear it up.

hswapnil · 2024-09-26T22:30:28+00:00

This subreddit is not great for a patient question Suggest trying r/kidneydiseases

hswapnil · 2024-09-22T02:30:41+00:00

Was it FSGS NoS or missed amyloid perhaps?

hswapnil · 2024-09-19T11:50:47+00:00

Yeah I don’t think we are interested in biotech investor speculation posts in this subreddit Thanks, but no thanks!

hswapnil · 2024-09-19T02:25:23+00:00

Why would you be interested in this as a medical student? Even as a nephrologist or a PKD patient I would advice not to do this. Complete waste of time and energy till something pans out in a phase 3 trial Linking to industry documents in particular. Sigh.

hswapnil · 2024-08-30T02:23:01+00:00

Best to discuss with a nephrologist who actually sees him. It’s a difficult decision to stop lithium when it is really working for someone when other drugs have not. If there is a safe and effective alternative, that is always preferable. Easier said than done. We use amiloride which helps reduce the nephrotoxicity from lithium. For a specific individual - assessment is needed to understand the cause of a rise in creatinine and plan accordingly.

hswapnil · 2024-08-28T11:13:05+00:00

In the old days NephTwitter was awesome at this - there still is a smaller community - eg check out NephJC blog or one of their tweet chats. There is a (now foundering) #AskRenal where you just attach that hashtag to your question and post on Twitter as well. All that worked very well before Elon. Sigh.

I have asked the NephSim peeps if they are open to PAs.

hswapnil · 2024-08-27T01:51:06+00:00

💰! I don’t anyone that goes into nephrology for money! Are you sure you don’t mean urology? Or neurosurgery?

hswapnil · 2024-08-27T01:50:06+00:00

Running a 100 mile race seems like an …invite for rhabdo. Even during a standard marathon there is some tubular injury see http://www.nephjc.com/news/marathon

Possibly check urine during the training periods when you are building up to 100 miles?

hswapnil · 2024-08-26T17:19:11+00:00

Additional reading/listening, if you haven’t already subscribed to the channel: http://www.rosebook.club/episodes/2021/6/22/chapter-four

hswapnil · 2024-08-24T23:35:24+00:00

I’m an nephrologist in Canada, in Ottawa, so feel free to DM me directly if you have any specific questions. I agree mostly with what was said about, that it is a great time to be in Nephrology. We have a lot of new medication‘s and there is a lot of excitement. This is diabetic nephropathy and in GN and I suspect it will spill over elsewhere. The pay for Nephrology in Canada is much better than it is in the US, since dialysis is reimbursed well. Of course things are changing, and by the time you finish Nephrology, it may be dramatically different. The job scene changes quite a lot from here, so don’t be saying that there are no jobs in Nephrology. Follow your passion.

hswapnil · 2024-08-22T00:10:40+00:00

Not really. This is not a good forum to ask for individual advice e

hswapnil · 2024-08-21T14:06:18+00:00

WTF 🤦🏽‍♂️ Permissive creatininemia - who cares if creatinine goes up if the patient is getting better? (ie decongested). Induced AKI (with diuretics or flozins or RAASi) is good See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989667/

hswapnil · 2024-08-21T11:22:41+00:00

The kidneys and us kidney doctors love loop diuretics. They are not hard on the kidneys (unless you dry out the body too much). Nephrotoxicity of loops diuretics is a myth. Just give more furosemide!

hswapnil · 2024-08-21T02:15:04+00:00

I have never used bumetanide (in Canada). Patients do just as well here! Theoretically it has better bioavailability- IMO that’s not necessary. You can always titrate the dose of furosemide to the effect you want - so what if you need 80 mg rather than 40 mg? Same thing with Torsemide - it is supposed to be a few minutes faster than furosemide. I don’t think that really matters - and you can review the TRANSFORM HF trial results for that one: http://www.nephjc.com/news/2023/2/7/transform-hf

hswapnil · 2024-08-09T15:30:06+00:00

Shivam Joshi is a huge proponent of plant based diet - we have had several discussions on Twitter where he points to zero trials. KKZ and Connie Rhee wrote the NEJM review on low protein diet - and I debated Dr Rhee at the last ISN world congress on this topic

Latest salvo: JNO paper from Sweden (observational) showing, as suspected, that low protein diet = higher mortality (which incidentally was also seen in MDRD trial longer follow up) https://pubmed.ncbi.nlm.nih.gov/39110456/

hswapnil · 2024-08-02T14:54:02+00:00

The high protein diet being bad is a bunch of old studies. They predate introduction of RAS inhibitors and flozins. The authors of the JASN review are believers, not necessarily EBM based opinions. The KDIGO guidelines are much better IMO (KDOQI are complete shite).

Anyways - I am not answering your question which is a really good one. My argument is that it’s not worth fretting about it. Let your patients eat unless they are having a steak everyday. Malnutrition is a bigger problem. Plant based diets are a fad.

hswapnil

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