Raphael
raphapalma.bsky.social
Raphael
@raphapalma.bsky.social
Nephrologist/Brazil
Reposted by Raphael
📣 Save the date!
🗓️ October 28, 12pm EST
Join us for a Space on Tropical AKI, Part 2
🎧 Set your reminder twitter.com/i/spaces/1gq...

🧠 Before the session, test your knowledge!
Take the quiz 👉 theisn.outgrow.us/Tropical_AKI
Let’s see how much you know about Tropical AKI before the experts dive in! 💪🌴
October 17, 2025 at 4:24 PM
Reposted by Raphael
✅Mayo MGRS Prediction Tool has good performance in finding the risk of MGRS in kidney biopsy in patients with MG
🔆Happy to contribute in this #videoabstract
🎉Thank you @theisn.org and @dilushiwijay.bsky.social for the opportunity
@myadla.bsky.social @arvindcanchi.bsky.social
𝗜𝗦𝗡 𝗩𝗜𝗗𝗘𝗢 𝗔𝗕𝗦𝗧𝗥𝗔𝗖𝗧 𝗦𝗘𝗥𝗜𝗘𝗦: The Mayo MGRS Prediction Tool calculates the risk of finding monoclonal gammopathy of renal significance in a kidney biopsy in patients with monoclonal gammopathy. 2025 from @kidneyint.bsky.social

By @kajareeg.bsky.social & @dilushiwijay.bsky.social
August 30, 2025 at 5:07 AM
Reposted by Raphael
🔥🫀ARNI showed superior cardioprotective effects.
May have renoprotective effects as per their molecular mechanism, but the evidence to date applies only to heart failure.
Future studies in CKD are needed, perhaps? 🤔
June 26, 2025 at 6:41 PM
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🔥SGLT2 Inhibitors: Game-changers!
They reduce HF hospitalisations, preserve GFR, slow CKD progression and improve outcomes in CRS.
🔹 Trials: DAPA-HF, EMPA-KIDNEY show mortality & renal benefits.
Do check out the link for the new SGLT2i toolkit there: theisn.org/initiatives/...
June 26, 2025 at 6:41 PM
Reposted by Raphael
See here an Evidence Table of RCTs Comparing Pharmacological Therapy for Fluid Overload and UF in Pts With Acute Decompensated HF
doi.org/10.1161/CIRC...
June 26, 2025 at 6:41 PM
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Decongestion Therapy
🔹 Loop diuretics = cornerstone
🔹 Use high doses for diuretic resistance; consider thiazides for synergy.
🔹 UF for refractory cases, but monitor renal function closely.
🔹 Aggressive diuresis improves outcomes even with transient ↑ creatinine.
June 26, 2025 at 6:41 PM
Reposted by Raphael
Key Principles in Rx
1️⃣ Decongestion (diuretics/ultrafiltration).
2️⃣ Neurohormonal modulation (RAASI, SGLT2i).
3️⃣ Volume assessment (CVP, intrarenal Doppler).
4️⃣ Treat underlying systemic disease (e.g., sepsis).
5️⃣ Multidisciplinary care
doi.org/10.3390/hear...
June 26, 2025 at 6:41 PM
Reposted by Raphael
What about management?
CRS management is about balance. It’s a tightrope walk between relieving congestion & preserving renal function. Let’s talk strategies.
Here is the strategy for acute cases, doi.org/10.3390/hear...
June 26, 2025 at 6:41 PM
Reposted by Raphael
Different imaging tech can also provide an overview of tissue damage and the overall function of the heart and kidneys
doi.org/10.3390/jpm1...
June 26, 2025 at 6:41 PM
Reposted by Raphael
🔬 Biomarkers of cardiac and kidney injury may provide important information when and can serve to indicate early cardiac or renal injury, the repair process, and long-term sequelae doi.org/10.1161/CIR....
Here is a list
June 26, 2025 at 6:41 PM
Reposted by Raphael
How do we diagnose it? doi.org/10.1161/CIRC...
We look at:
Biomarkers: NT-proBNP, cystatin C, NGAL, KIM-1
Imaging: Echo (CVP, LVEF), renal US (exclude obstruction)
Volume status: Clinical exam + POCUS
June 26, 2025 at 6:41 PM
Reposted by Raphael
Congestion vs Perfusion
For years, we thought hypoperfusion drove CRS.
🔥Turns out, congestion is the bigger villain. High venous pressure, intra-abdominal pressure (IAP), and renal compression all hurt GFR.
doi.org/10.3389/fphy...
June 26, 2025 at 6:41 PM
Reposted by Raphael
🫀🔥Now, the million-dollar question: Why does this happen?
—it’s a cocktail of mechanisms: 🩺
Central players:
Congestion → ↓ Renal perfusion
RAAS & SNS activation → Maladaptive changes
Inflammation & oxidative stress → Organ damage
doi.org/10.1161/CIR....
Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association | Circulation
Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other orga...
doi.org
June 26, 2025 at 6:41 PM
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🔑What is CRS?
nature.com/articles/nrn...
Types of CRS:
1️⃣ Type I: Acute HF → AKI
2️⃣ Type II: Chronic HF → CKD
3️⃣ Type III: AKI → Acute HF
4️⃣ Type IV: CKD → Chronic HF
5️⃣ Type V: Systemic diseases (e.g., sepsis) → Combined dysfunction
June 26, 2025 at 6:41 PM
Reposted by Raphael
🚨 Cardiorenal Syndrome (CRS): A Deadly Duo 🚨
Did you know the heart & kidneys are so intertwined that dysfunction in one can wreak havoc on the other?
Let's dive into CRS today.
A lucid read for every nephrology & cardiology fellow 🫀🩺
#MedTwitter
#ISNTweetorial
June 26, 2025 at 6:41 PM
Reposted by Raphael
🌍 Today is #IgANAwarenessDay!

Join the ISN in raising awareness of IgA Nephropathy (#IgAN), a rare but impactful kidney disease.

📚 Explore the ISN's dedicated IgAN resources, all available through the Rare Kidney Diseases Toolkit: www.theisn.org/initiatives/...
Rare Kidney Diseases Toolkit - International Society of Nephrology
www.theisn.org
May 14, 2025 at 8:52 PM
Reposted by Raphael
As WHA78 unites global health leaders, kidney care must stay a priority. 🗳️ We urge Member States to back the kidney health resolution. Explore the ISN-GKHA Map for key insights.

🔗 http://lite.spr.ly/6...

#ISNGKHA #WHA78 #KidneyHealthMatters #UHC
International Society of Nephrology: ISN-Global Kidney Health Atlas
Explore comprehensive data on global kidney care readiness and delivery across countries and regions. Based on the International Society of Nephrology's worldwide survey, this interactive atlas helps inform healthcare policy and advocacy for improved kidney disease treatment.
lite.spr.ly
May 15, 2025 at 6:00 AM
Reposted by Raphael
𝗦𝗔𝗩𝗘 𝗧𝗛𝗘 𝗗𝗔𝗧𝗘 for our next @theisn.org Space for #WorldHypertensionDay: "Hypertension and the Kidneys."
#Nephpearls #NephSky

🗓️ May 22
🕑 3:00 pm CEST

👉🏼 twitter.com/i/spaces/1jM...
May 15, 2025 at 12:08 AM
Reposted by Raphael
Great meeting with the @ISNEducation social media team; lots of exciting projects on the horizon!
We're looking forward to what’s coming next, so stay tuned!
May 15, 2025 at 3:40 PM
Reposted by Raphael
📖 This weekend don't miss our @kidneyint.bsky.social #ISNFridaySelection: Pathological findings of immunotherapy-induced nephrotoxicity in a humanized immune system mouse model www.kidney-internati...
May 16, 2025 at 6:00 AM
Reposted by Raphael
𝗜𝗦𝗡 𝗩𝗜𝗗𝗘𝗢 𝗔𝗕𝗦𝗧𝗥𝗔𝗖𝗧 𝗦𝗘𝗥𝗜𝗘𝗦: The effects of plasma exchange and glucocorticoids on early kidney function among patients with ANCA-associated vasculitis in the PEXIVAS trial. 2025 from @kidneyint.bsky.social www.kidney-internati...

#VideoAbstract by @drsumanbehera.bsky.social
May 16, 2025 at 12:00 PM
Reposted by Raphael
#1 Today is World HTN Day!
🧑‍🤝‍🧑1.3 billion people live with HTN, but only 1 in 5 meet BP goals.
⚠️HTN silently drives stroke, heart & kidney failure—and 57% of global deaths.

Check this beautiful Infographic by @gabyneph.bsky.social

#ISNTweetorial #WorldHypertensionDay
May 17, 2025 at 6:55 AM
Reposted by Raphael
ISN Quiz alert!!
📌HTN remains the leading global contributor to reno cardiovascular death and disability.
📌Take this evidence-based quiz from ISN SoMe team members to assess your knowledge and improve patient care. Here’s the link for the quiz: theisn.outgrow.us/HTN_2025
Interactive Calculators & Quizzes
Easily create interactive experiences that increase conversion and bring traffic.
theisn.outgrow.us
May 17, 2025 at 1:34 PM
Reposted by Raphael
🎉 20 Years of #WorldKidneyDay! 🎉

Since its launch, World Kidney Day has raised global awareness of kidney health. The 2025 campaign #AreYourKidneysOK highlights the importance of #EarlyDetection in preventing and managing kidney disease.
🔗 Learn more: www.worldkidneyday.o...
#KidneyHealthMatters
March 13, 2025 at 7:00 AM
Reposted by Raphael
🌎Are your kidneys OK?
Get them checked! And spread kidney awareness! #WorldKidneyDay #NephSky #MedSky @theisn.org @sandhyasuresh.bsky.social @raphapalma.bsky.social
March 13, 2025 at 3:56 AM