@grahamabra.bsky.social
Nephrologist @StanfordNeph, Chair @HDAE_Official, Director Social Media @HemodialysisInt, Defender of the 4 nephrons.
I have not, COL4A3 and 4 heterozygotes
November 9, 2025 at 9:28 PM
I have not, COL4A3 and 4 heterozygotes
Agreed - already have some proactive DMI folks on Finerenone - has been safe and lowers proteinuria in my hands
November 7, 2025 at 8:13 PM
Agreed - already have some proactive DMI folks on Finerenone - has been safe and lowers proteinuria in my hands
I think many of us like to practice this way - conservative management of AKI-D but hospital discharge planners and teams often are inpatient for a schedule for discharge
Monitoring and Management of AKI-D in our outpatient HD centers is messy
Monitoring and Management of AKI-D in our outpatient HD centers is messy
November 7, 2025 at 7:56 PM
I think many of us like to practice this way - conservative management of AKI-D but hospital discharge planners and teams often are inpatient for a schedule for discharge
Monitoring and Management of AKI-D in our outpatient HD centers is messy
Monitoring and Management of AKI-D in our outpatient HD centers is messy
Typically young and healthy so not getting regular labs
November 6, 2025 at 8:51 PM
Typically young and healthy so not getting regular labs
Awesome slides and summary thread.
New group showing up in my clinic are prospective parents who have undergone genetic screening prior to conception and found to have pathogenic type IV collagen gene variants
Not getting identified because of blood/urine testing but because of genetic screening!
New group showing up in my clinic are prospective parents who have undergone genetic screening prior to conception and found to have pathogenic type IV collagen gene variants
Not getting identified because of blood/urine testing but because of genetic screening!
November 6, 2025 at 8:49 PM
Awesome slides and summary thread.
New group showing up in my clinic are prospective parents who have undergone genetic screening prior to conception and found to have pathogenic type IV collagen gene variants
Not getting identified because of blood/urine testing but because of genetic screening!
New group showing up in my clinic are prospective parents who have undergone genetic screening prior to conception and found to have pathogenic type IV collagen gene variants
Not getting identified because of blood/urine testing but because of genetic screening!
That’s great that it’s just a single E. coli organism
Always worry about a polymicrobial infection when there’s a potential bowel perforforation
Would do 3 weeks of daily IP Ceftaz with nystatin PO fungal prophy for the full course + 5 days after
Always worry about a polymicrobial infection when there’s a potential bowel perforforation
Would do 3 weeks of daily IP Ceftaz with nystatin PO fungal prophy for the full course + 5 days after
November 3, 2025 at 5:47 PM
That’s great that it’s just a single E. coli organism
Always worry about a polymicrobial infection when there’s a potential bowel perforforation
Would do 3 weeks of daily IP Ceftaz with nystatin PO fungal prophy for the full course + 5 days after
Always worry about a polymicrobial infection when there’s a potential bowel perforforation
Would do 3 weeks of daily IP Ceftaz with nystatin PO fungal prophy for the full course + 5 days after
Anying growing from the culture?
If gram positive polymicrobial often a better prognosis and response than if gram negative and of course fungal pathogens are in the mix.
If gram positive polymicrobial often a better prognosis and response than if gram negative and of course fungal pathogens are in the mix.
November 2, 2025 at 4:14 PM
Anying growing from the culture?
If gram positive polymicrobial often a better prognosis and response than if gram negative and of course fungal pathogens are in the mix.
If gram positive polymicrobial often a better prognosis and response than if gram negative and of course fungal pathogens are in the mix.
Reposted
If you get a clearly pathogenic COL4A5 variant you might be able to stop after genetic testing, but a single COL4A3/4 variant doesn’t tell you what’s going on in the kidney. Still need biopsies. #NephJC
October 29, 2025 at 1:49 AM
If you get a clearly pathogenic COL4A5 variant you might be able to stop after genetic testing, but a single COL4A3/4 variant doesn’t tell you what’s going on in the kidney. Still need biopsies. #NephJC
Agreed - gets back to the original point, mechanistically appealing but no trial to support
MMF+steroid+obi vs MMF+steroid had to prove itself in LN (remember ritux failed even when mechanistically appealing)
Same rigorous eval should happen in IgA Nephropathy
#NephJC
MMF+steroid+obi vs MMF+steroid had to prove itself in LN (remember ritux failed even when mechanistically appealing)
Same rigorous eval should happen in IgA Nephropathy
#NephJC
October 29, 2025 at 2:59 PM
Agreed - gets back to the original point, mechanistically appealing but no trial to support
MMF+steroid+obi vs MMF+steroid had to prove itself in LN (remember ritux failed even when mechanistically appealing)
Same rigorous eval should happen in IgA Nephropathy
#NephJC
MMF+steroid+obi vs MMF+steroid had to prove itself in LN (remember ritux failed even when mechanistically appealing)
Same rigorous eval should happen in IgA Nephropathy
#NephJC
That’s part of the (good) problem here
On the best background therapy, say sparsentan+SGLT2i, does adding another agent lower ESKD risk?
I’m doing it but I don’t know if the TRF budesonide or iptacopan I’m adding is doing anything but it makes me and the pt feel good if UPCR goes down
#NephJC
On the best background therapy, say sparsentan+SGLT2i, does adding another agent lower ESKD risk?
I’m doing it but I don’t know if the TRF budesonide or iptacopan I’m adding is doing anything but it makes me and the pt feel good if UPCR goes down
#NephJC
October 29, 2025 at 2:44 PM
That’s part of the (good) problem here
On the best background therapy, say sparsentan+SGLT2i, does adding another agent lower ESKD risk?
I’m doing it but I don’t know if the TRF budesonide or iptacopan I’m adding is doing anything but it makes me and the pt feel good if UPCR goes down
#NephJC
On the best background therapy, say sparsentan+SGLT2i, does adding another agent lower ESKD risk?
I’m doing it but I don’t know if the TRF budesonide or iptacopan I’m adding is doing anything but it makes me and the pt feel good if UPCR goes down
#NephJC