Maybe further trials comparing it with Nefecon or Sparsentan - drugs already proven to reduce proteinuria/eGFR slope, would enlighten us better as to which is better, and also help us decide on cost comparison (Albeit, once they’re available here 😅).

#NephJC

These are the interventions:
- SoC alone
- Low dose steroids
- Gut directed (NOT targeted release) budesonide
- MMF
- Hydroxychloroquine
- later Finerenone once generic in India

Great choices!

#NephSky #ISNWCN
4/

Yes my exact opinion, guidelines may be evolving and improving but what happens in reality?

Our patients either come with a creat of 8,
Or they’re loaded with steroids for quite long without even SGLT2i or ARBs many times, and they’re just victims of therapeutic misadventure.
Sorry state. #NephJC

Non-immunologic therapies also have important disease-specific benefits that are often underused.
#NephJC

In countries like India, drug sales, doses, and indications are poorly regulated → frequent misuse.

#NephJC

Protein powders for CKD - like NeproHP/ RenHP are a fad ! They have a very poor protein density with increased carbs and cost much more than what they’re worth !
The costs are exorbitant - more so considering our patients’ economic state!

#NephJC

Yes, our practices are changing. But most of our patients go to their “local doctor” or Ayurvedic doctor who again says that if they take less protein their kidneys can be saved - again highlighting the gross misconceptions among treating physicians too ! #NephJC

Great Chat. Big thanks to @nephromommy-akshu.bsky.social and @roxnonna23.bsky.social the crisp #NephJC summary 🙌. Thanks for waking me up Akshaya. Grateful! 🙏

But I don’t see it going beyond the small privileged group of HLA matched patients !

There are too many IFs and BUTs involved
#NephJC

The problem here is that - as attractive as being IS free sounds - it comes with a huge load right from patient selection, ensuring HLA compatibility, putting a huge burden on donors (making the MDR 101) and a very high risk IS withdrawal trial - with risk of rejection for the KTRs #NephJC

Let's remember operational tolerance isn't always induced. Some patients, especially HLA-matched can already come off IS without MDR-101. We need better biomarkers to find these "spontaneous tolerants." #NephJC

Fascinating finding: many patients lost chimerism but stayed IS-free. 🤔 This suggests chimerism is a transient 'switch' to turn on tolerance, not the long-term mechanism itself. We urgently need to identify that mechanism for safer weaning protocols. #NephJC

The conditioning regimen (rATG + TLI) is a big deal. For non-malignant disease, the risk of severe infections should definitely be considered in depth. Infection risks remain a huge obstacle for routine adoption. #NephJC

Wasn't invited for the twinning photo.
Guess I’ll stick to mixed chimerism in renal transplants for my twinning goals.

It was. The book is focuses on the history of TB, but it’s definitely not historical. In India, it’s our present. TB plagues all communities and classes, and it’s probably nothing to be proud of, that I seem to know and see most of these situations day-in and out !
#NephJC