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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 13h

it’s definitely still I-G-A nephropathy 🤓

Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 14h

I used it quite a lot (ie. all DKD already on max RAASi + SGLT2i and the 14 patients we have enrolled in FIND-CKD) and I have so far not seen significant hyperK or had to discontinue finerenone.
Discontinue quite a lot of antihypertensives, though…

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 5d

and how will the IgAN risk prediction tool work in the future? I find it hard enough to use already when it is only validated for RAASi and steroids. With DEARA, complement inhibition, APRIL/BAFF, anti-CD38, etc., will it even have any relevance?

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 5d

perhaps the budesonide is playing a part in the rising eGFR. We don’t have access to this.

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 6d

not the rise in eGFR, but definitely seen IgAN with reduction in proteinuria to <0.3 g/d on RAASi+SGLT2i and strict blood pressure control.
Great relief to patients (and myself) 🤓

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 6d

Agree with RAASi+SGLT2i as background, but could make the argument it should be DEARA+SGLT2i.
Neither DEARA nor budenoside are reimbursed in Denmark, so moot point for us…

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 11d

seem still to be recruiting for the phase 3 trial
clinicaltrials.gov/study/NCT053...
Is there any other gossip? 🤓

Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 13d

Re bigger/better labs - as a famous Danish foreign secretary once said, “If you can’t beat them, join them”. Hardly anyone can make do with just their own lab anymore, you need to collaborate.

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 13d

Personally, besides transferable skills, the main benefit of my PhD was the many hours reading. I read so much that by the time I started my formal nephrology training, I was way ahead on pathophysiology and theory. Experience was lacking, that came later, but the PhD gave me a higher starting point

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 13d

Definitely agree regarding cost/effectiveness, but in the other hand you never know which project will strike gold. Basic research has to just forge ahead, even if the end goal is not clear. If only 1 in 100 projects have major impact, how do you know it won’t be yours?

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 15d

A little opinion piece on the relationship between serum calcification propensity (T50) and progressive CAC in kidney transplant recipients 🤓
www.kireports.org/article/S246...

T50 and Calcification Progression in Kidney Transplant Recipients: Does it have to be “bad” to be useful?

The increased risk of cardiovascular disease (CVD) among kidney transplant recipients (KTR)1 is challenging for the treating physician. For KTR, CVD risk remains higher than for individuals with simil...

www.kireports.org

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Reposted by Iain Bressendorff, MD PhD

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 16d

And it’s live

Iptacopan in C3GN makes it to @thelancet.com

www.thelancet.com/journals/lan...

#NephSky

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Reposted by Iain Bressendorff, MD PhD

Jonathan Zuckerman MD PhD @jzrenalpath.bsky.social · Aug 6

Wide variety of morphologies in this case of crystalline light chain proximal tubulopathy: mottle lysosomes, crystals, and fibrils. #renalpath #nephsky #pathsky

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Reposted by Iain Bressendorff, MD PhD

grahamabra.bsky.social @grahamabra.bsky.social · 28d

Have hyperglycemia (and other DM badness) been hiding in plain sight in ESKD?

Probably.

Great study using CGMs in ESKD.

Pts with treated DM, mean TIR only 43% while mean HbA1c was 7.0%

journals.lww.com/jasn/abstrac...

Glycemia Assessed by Continuous Glucose Monitoring among... : Journal of the American Society of Nephrology

ilure and its treatments disrupt glucose homeostasis in ways that may promote both hyperglycemia and hypoglycemia. Continuous glucose monitoring (CGM) delineates detailed glycemic profiles, but publis...

journals.lww.com

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 28d

that’s pretty wild. Do we know if there are more non-renal microvascular complications in PD vs HD? Neuropathy or retinopathy?

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 29d

Agree.
Also from TESTING
www.kireports.org/article/S246...
higher urine sCD163 associates with greater effect of steroids, but people with lower levels still benefit. So doesn’t help
much in deciding who to treat and who not to

Correlation of Urinary Soluble CD163 Levels With Disease Activity and Treatment Response in IgA Nephropathy

The TESTING trial demonstrated that corticosteroids reduce the risk of kidney failure in patients with IgA nephropathy (IgAN) but increase the risk of serious adverse events. Reliable noninvasive biom...

www.kireports.org

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · 29d

so, what do we do about it?
Why is there less interaction on Bluesky than old Twitter?
Is it just that not all people have transitioned to Bluesky?
Or are other proactive measures needed?

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · Sep 7

if you have a biopsy with no histological changes then that can be labelled MCD. But it has to be in the context of nephrotic syndrome. I have seen patients with various other conditions labelled as MCD after biopsy without lesions.

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · Sep 7

I wonder about the MCD numbers. How often does one see ESKD from MCD? I remember one case with very bad AKI, who never recovered from the initial nephrosis. Everyone else has on/off nephrotic syndrome, but no progression.
Is the MCD diagnosis in RaDaR in many cases in fact something else?

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Reposted by Iain Bressendorff, MD PhD

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · Aug 23

RIP Nicolas Madias

Of the Adrogue-Madias formula and much more

I don’t know he wrote three textbooks as a medical student!

www.kidney-international.org/article/S008...
In @kidneyint.bsky.social

#NephSky

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · Aug 13

Same here. Only remember one mild case with good outcome, everyone else showed up too late and dialysis-dependent at presentation.

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · Aug 13

okay, so different phenotype.

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · Aug 13

have you seen patients develop DAH after initially only having renal involvement?

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · Aug 13

I see now that this is actually the suggested strategy in the KDIGO 2021 guidelines. Missed it as it is only in the flowchart, not mentioned in the text. Thanks 😃

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Iain Bressendorff, MD PhD @ibressendorff.bsky.social · Aug 13

No risk of DAH at a later time?

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