Swapnil Hiremath 🍁🇨🇦
@hswapnil.medsky.social
Nephrologist = kidney doctor
MD, MPH
Professor, University of Ottawa/Ottawa Hospital 🇨🇦
He/Him/His
#NephJC co-creator; @FreelyFiltered.bsky.social pod panelist; KICR EiC
https://www.swapnilhiremath.com
MD, MPH
Professor, University of Ottawa/Ottawa Hospital 🇨🇦
He/Him/His
#NephJC co-creator; @FreelyFiltered.bsky.social pod panelist; KICR EiC
https://www.swapnilhiremath.com
Pinned
If you are a nephrology or kidney disease or renal professional or interested in the field - make sure you have liked/followed/pinned the nephrology feed
bsky.app/profile/did:...
Thanks again to @richardferro.xyz for creating & updating this! It’s a one-stop shop for nephrology needs
#NephSky
bsky.app/profile/did:...
Thanks again to @richardferro.xyz for creating & updating this! It’s a one-stop shop for nephrology needs
#NephSky
Update
Link changed (will not change again)
So if you liked/pinned the old feed, please do it again!
bsky.app/profile/did:...
#NephSky
Link changed (will not change again)
So if you liked/pinned the old feed, please do it again!
bsky.app/profile/did:...
#NephSky
Reposted by Swapnil Hiremath 🍁🇨🇦
No doubt; in comparing the roles of the intestinal to the urinary microbiomes @lamanazzal.bsky.social and I would argue the former is clearly more important, with the potential of changing urinary chemistry. The role of the latter remains unclear but under active investigation.
February 11, 2026 at 9:41 PM
No doubt; in comparing the roles of the intestinal to the urinary microbiomes @lamanazzal.bsky.social and I would argue the former is clearly more important, with the potential of changing urinary chemistry. The role of the latter remains unclear but under active investigation.
Reposted by Swapnil Hiremath 🍁🇨🇦
Thanks Swap, a potentially very important paper from my collaborator Kymora Scotland at UCLA. New methods in microscopy applied to demonstrate findings c/w bacterial biofilms while DNA sequences suggest E. coli, Proteus, enterococcus. KS says she has 2 more important papers on this work!
Intercalated bacterial biofilms are intrinsic internal components of calcium-based kidney stones
Bacteria are traditionally believed to contribute only to struvite kidney stone formation. In contrast, most types of kidney stones are believed to be abiotic and considered to be “noninfectious.” Here we show that calcium oxalate stones, the most ...
pmc.ncbi.nlm.nih.gov
February 11, 2026 at 9:38 PM
Thanks Swap, a potentially very important paper from my collaborator Kymora Scotland at UCLA. New methods in microscopy applied to demonstrate findings c/w bacterial biofilms while DNA sequences suggest E. coli, Proteus, enterococcus. KS says she has 2 more important papers on this work!
Reposted by Swapnil Hiremath 🍁🇨🇦
it's wild how badly people dose hypertonic therapy
60 ml of 23% is equivalent to ~500 ml 3%, so this article makes no coherent sense
best approach: figure out the sodium change you want and calculate the hypertonic dose
math sets you free from dozens of contradictory consensus statements #EMIMCC
60 ml of 23% is equivalent to ~500 ml 3%, so this article makes no coherent sense
best approach: figure out the sodium change you want and calculate the hypertonic dose
math sets you free from dozens of contradictory consensus statements #EMIMCC
February 11, 2026 at 9:15 PM
it's wild how badly people dose hypertonic therapy
60 ml of 23% is equivalent to ~500 ml 3%, so this article makes no coherent sense
best approach: figure out the sodium change you want and calculate the hypertonic dose
math sets you free from dozens of contradictory consensus statements #EMIMCC
60 ml of 23% is equivalent to ~500 ml 3%, so this article makes no coherent sense
best approach: figure out the sodium change you want and calculate the hypertonic dose
math sets you free from dozens of contradictory consensus statements #EMIMCC
Reposted by Swapnil Hiremath 🍁🇨🇦
This is the aftermath of an ICE kidnapping a few blocks from my home in St. Paul—an hour ago. A quiet street full of broken glass and at least three wrecked cars. The target of the kidnapping was taken away by ambulance. He was on a stretcher and covered by a sheet, though a cop said he was alive.
February 11, 2026 at 4:46 PM
This is the aftermath of an ICE kidnapping a few blocks from my home in St. Paul—an hour ago. A quiet street full of broken glass and at least three wrecked cars. The target of the kidnapping was taken away by ambulance. He was on a stretcher and covered by a sheet, though a cop said he was alive.
Reposted by Swapnil Hiremath 🍁🇨🇦
like the problem isn't SKYNET, the problem is letting amoral extraction class assholes apply half-cooked automation onto deeply broken sectors in exploitative ways in a country that's too corrupt to have functioning regulators
UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges
For the largest health insurer in the US, AI's error rate is like a feature, not a bug.
arstechnica.com
February 11, 2026 at 4:26 PM
like the problem isn't SKYNET, the problem is letting amoral extraction class assholes apply half-cooked automation onto deeply broken sectors in exploitative ways in a country that's too corrupt to have functioning regulators
Reposted by Swapnil Hiremath 🍁🇨🇦
So true, and especially important when discussing culturally sensitive nutrition recommendations. Blanket avoidance of entire foods seems cruel, especially when it's a healthy, whole, easily accessible food like banana, beans, etc. It all seems more of a knee-jerk reaction vs. EBM #NephJC
February 11, 2026 at 2:38 PM
So true, and especially important when discussing culturally sensitive nutrition recommendations. Blanket avoidance of entire foods seems cruel, especially when it's a healthy, whole, easily accessible food like banana, beans, etc. It all seems more of a knee-jerk reaction vs. EBM #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
This doesn’t even mention the millions taken from seniors by predatory political campaigns.
February 11, 2026 at 1:01 PM
This doesn’t even mention the millions taken from seniors by predatory political campaigns.
Reposted by Swapnil Hiremath 🍁🇨🇦
Am I missing something?
The FDA has warned Novo Nordisk that their ad for the new Wegovy pill is misleading, and therefore distribution is in violation of the FD&C Act.
Here's the text of the ad, per the FDA.
(Reposting, this time with the actual text.)
www.fda.gov/media/191020...
The FDA has warned Novo Nordisk that their ad for the new Wegovy pill is misleading, and therefore distribution is in violation of the FD&C Act.
Here's the text of the ad, per the FDA.
(Reposting, this time with the actual text.)
www.fda.gov/media/191020...
February 11, 2026 at 11:40 AM
Am I missing something?
The FDA has warned Novo Nordisk that their ad for the new Wegovy pill is misleading, and therefore distribution is in violation of the FD&C Act.
Here's the text of the ad, per the FDA.
(Reposting, this time with the actual text.)
www.fda.gov/media/191020...
The FDA has warned Novo Nordisk that their ad for the new Wegovy pill is misleading, and therefore distribution is in violation of the FD&C Act.
Here's the text of the ad, per the FDA.
(Reposting, this time with the actual text.)
www.fda.gov/media/191020...
Reposted by Swapnil Hiremath 🍁🇨🇦
Associations of Novel Triglyceride- and Triglyceride–Glucose-Derived Obesity Indices With Hypertension in Nonobese US Adults (NHANES 1999–2020)
🔗 academic.oup.com/ajh/article-... 🔒
🔗 academic.oup.com/ajh/article-... 🔒
Associations of Novel Triglyceride- and Triglyceride–Glucose-Derived Obesity Indices With Hypertension in Nonobese US Adults (NHANES 1999–2020)
AbstractBACKGROUND. Visceral obesity, insulin resistance, and glycolipid abnormalities are associated with an increased risk of hypertension (HTN). The stu
academic.oup.com
February 11, 2026 at 11:01 AM
Associations of Novel Triglyceride- and Triglyceride–Glucose-Derived Obesity Indices With Hypertension in Nonobese US Adults (NHANES 1999–2020)
🔗 academic.oup.com/ajh/article-... 🔒
🔗 academic.oup.com/ajh/article-... 🔒
Reposted by Swapnil Hiremath 🍁🇨🇦
T2e
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
February 11, 2026 at 2:36 AM
T2e
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
Turning to kidney function — the most consistent physiologic effect.
Using iohexol clearance, dapagliflozin caused an acute dip in measured GFR.
The placebo-adjusted mGFR decline was:
– 4.2 ml/min/1.73 m² at 1 week
– 3.5 ml/min/1.73 m² at 12 weeks
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T2f
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
February 11, 2026 at 2:37 AM
T2f
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
Creatinine-based eGFR showed directionally similar changes, closely mirroring the early hemodynamic dip seen in native-kidney SGLT2i trials.
Crucially, this GFR dip was not accompanied by harm:
❌ No excess AKI
❌ No biochemical instability
❌ No signal for acute rejection
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T1b
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
February 11, 2026 at 2:19 AM
T1b
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
Participants were stable kidney transplant recipients, ≥6 months post-transplant.
Initially restricted to patients with diabetes, eligibility was later expanded to non-diabetic recipients after publication of DAPA-CKD. #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T0b
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
February 11, 2026 at 2:08 AM
T0b
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
The dominant drivers of late graft failure and death are:
❤️ Cardiovascular disease (Death with a functioning graft) ⛔ Progressive graft failure from immune and non-immune injury. #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T0i
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
February 11, 2026 at 2:15 AM
T0i
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
So here comes the quintessential, key unanswered question:
👉 Do SGLT2 inhibitors exert similar, altered, or entirely different physiologic effects in kidney transplant recipients—and more importantly are they safe? 📉 📈
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
Reposted by Swapnil Hiremath 🍁🇨🇦
T0g
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
February 11, 2026 at 2:13 AM
T0g
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
However, kidney transplant recipients have been excluded from all major SGLT2i outcome trials—creating a major evidence gap. For better (overly cautious) or worse, we have limited safety and efficacy data for renal transplant patients. #NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
T0h
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
February 11, 2026 at 2:14 AM
T0h
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
Transplanted kidneys are physiologically distinct from native kidneys.
Denervated, exposed to calcineurin inhibitors, and characterized by altered sodium handling and vascular tone are just a few of the significant differences.
Can you think of others?
#NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
⚡INTRODUCTION: ⚡
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
February 11, 2026 at 2:07 AM
⚡INTRODUCTION: ⚡
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
T0a
Welcome to #NephJC !
Let’s start with the big picture.
Transplantation remains the best RRT for survival and quality of life. Yet long-term graft survival has plateaued, with ~50% graft loss by 10 years.
Reposted by Swapnil Hiremath 🍁🇨🇦
📰Check out the insightful summary by Sai vani Yellampalli Dr SaiVani Yellampalli
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
February 11, 2026 at 2:02 AM
📰Check out the insightful summary by Sai vani Yellampalli Dr SaiVani Yellampalli
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
Bogdan Agavriloaei Bogdan Agavriloaei and me Akshaya Jayachandran
#NephJC
www.nephjc.com/news/...
To INFINITI and Beyond: SGLT2 Inhibitors in Kidney Transplant Patients — NephJC
Reposted by Swapnil Hiremath 🍁🇨🇦
Reposted by Swapnil Hiremath 🍁🇨🇦
The simplest rule is to be kind and inclusive while you use your wit! Here are #NephJC values, summarized by Sinead Stoneman
February 11, 2026 at 2:01 AM
The simplest rule is to be kind and inclusive while you use your wit! Here are #NephJC values, summarized by Sinead Stoneman
February 11, 2026 at 2:00 AM
Reposted by Swapnil Hiremath 🍁🇨🇦
Assuming its #TulipTuesday, some Tulips from 2024 - around Parliament Hill and Major Hill’s Park
#FlowerSky 🌷
#FlowerSky 🌷
February 11, 2026 at 1:57 AM
Assuming its #TulipTuesday, some Tulips from 2024 - around Parliament Hill and Major Hill’s Park
#FlowerSky 🌷
#FlowerSky 🌷