Izabela Zakrocka

New Discovery May Improve Kidney Disease Diagnosis in Black Patients A closer examination of the APOL1 gene in Black patients with kidney disease can provide more precise diagnoses than current protocols.

and a little press release from @columbiauniversity.bsky.social
www.cuimc.columbia.edu/news/new-dis...

@columbiakidney.bsky.social
@isgd.bsky.social
@cuimcglomcenter.bsky.social
@glomcon.org

Precision Diagnosis in APOL1 Kidney Disease With p.N264K M1 Protective Variant This case-control study evaluates whether, in patients with APOL1 high-risk genotype kidney disease with at least 1 G2 allele, M1 can distinguish APOL1 chronic kidney disease from non-APOL1 chronic ki...

Online today on @jamanetworkopen.com our new paper on the role of #APOL1 M1 in increasing precision diagnosis for CKD in individuals from African ancestry.
Collaboration with
@kidneyomicsamps.bsky.social @gbadegesinlab.bsky.social @kirylukk.bsky.social et al

jamanetwork.com/journals/jam...

Is anyone using obinutuzumab for maintenance in SLE (I know there is no data)?
Have young pt with LN III/IV, MMF + prednisone induction. Doing well, but persistently high dsDNA, C3/C4 normal.
@kidneydoc101.bsky.social @juancarlosqvelez.bsky.social @kronbichlerlab.bsky.social @grahamabra.bsky.social

SGLT2-inhibitors in adult patients with Alport Syndrome Alport syndrome (AS) is a genetically heterogenous kidney disease characterised by microhaematuria, proteinuria, and progressive chronic kidney disease (CKD). Although early renin-angiotensin system i...

SGLT2 inhibitors in adult patients with Alport Syndrome
#nephsky #nephrology
www.kireports.org/article/S246...

NephMadness brackets

Some of these are easy (Targeted B cell >>> complement in IgA) so unless #BRPFail we should be OK

Many others are hard

And

🐕 🐶 versus 🐈 🐱 🐈‍⬛??

That’s madness. True #NephMadness 🫡

Can Ozempic Cure Addiction? GLP-1 drugs, which have helped some people curb drug and alcohol use, may unlock a pathway to moderation.

Dhruv Khullar on GLP1RA and addiction in the latest New Yorker

www.newyorker.com/magazine/202...

Self recommending

(If you don’t have sub, most public libraries have it, and can read instantaneously with Libby)

Real-World Hospitalization Outcomes with On-Line Hemodiafiltration Versus High-Flux Hemodialysis ca. 2025 from @asnpublications.bsky.social
#Nephpearls #NephSky

#VisualAbstract by @husamjz.bsky.social

👉 pubmed.ncbi.nlm.nih.gov/41433104/

This really is a great picture:

Lecithin-cholesterol acyltransferase deficiency with the finding of “zebra bodies”: A diagnostic challenge in the context of suspected Fabry disease Lecithin-cholesterol acyltransferase (LCAT) deficiency is a rare autosomal recessive disorder resulting from mutations in the LCAT gene, which leads t…

Lecithin-cholesterol acyltransferase deficiency with the finding of “zebra bodies”: A diagnostic challenge in the context of suspected Fabry disease
#nephsky #nephrology
www.sciencedirect.com/science/arti...

figure 1

sweet

A @asnpublications.bsky.social perspective argues we need a Spironolactone versus nsMRA head:head trial!

journals.lww.com/jasn/pages/a...

Bring it on!

#NephSky #SpiroStans rejoice

Mechanism of action of zilebesiran (double-stranded siRNA conjugated to trivalent GalNAc targeting angiotensinogen mRNA). Zilebesiran is a first-in-class siRNA targeting hepatic angiotensinogen production.11,12 Zilebesiran has been chemically modified to optimise its pharmacokinetic, pharmacodynamic, and safety profiles and is conjugated to trivalent GalNAc, which binds to ASGPR on hepatocytes, enabling targeted liver delivery. After receptor-mediated endocytosis, siRNA escapes from endosomes into the cytosol and is incorporated into the RISC. The guide strand directs RISC to angiotensinogen mRNA, leading to its cleavage (depicted by the thunderbolt symbol) and suppression of hepatic angiotensinogen synthesis. A single administration maintains efficacy for up to 6 months. Copyright: 2025 Elsevier Ltd. All rights are reserved.

Arterial hypertension affects an estimated 25–30% of adults worldwide.

Innovative approaches are needed to improve hypertension care.

A new Therapeutics Review explores new drug therapies for hypertension: spkl.io/63322AtTNi

Figure showing the effect of statin versus placebo on events listed in statin SmPCs, subdivided by component parts. Results for two outcomes with fewer than ten events are not shown in the figure, but are included in the appendix. FDR=false discovery rate. LFT=liver function test. RBC=red blood cell. RR=rate ratio. SmPC=Summary of Product Characteristics. *FDR significant at the 5% level; RR for results FDR-significant at the 5% level are indicated by black circles and RR for results not FDR-significant at the 5% level indicated by grey circles. †Excluded from FDR testing; RR for results excluded from FDR testing indicated by white circles.

Almost all side effects on statin labels not caused by statins, finds major meta-analysis; authors call for labels to be updated.

Find out more 👉 spkl.io/63324AsjHO

Damage from a heart attack comes from brain signals, mouse study suggests Nature - The brain and vagus nerve play a key role in exacerbating tissue damage after a heart attack, but there are ways to block it.

The brain and vagus nerve play a key role in exacerbating tissue damage after a heart attack, but there are ways to block it

go.nature.com/3ZG17Jr

And KYNA! = tryptophan metabolite

Predicting OCT2/MATEs‐Mediated Drug Interactions in Healthy Volunteers and Patients with Chronic Kidney Disease: Insights from Extended Clearance Concept, Endogenous Biomarkers, and In Vitro Inhibition Studies (Perspectives from the International Transporter Consortium) Organic cation transporter (OCT) 2 and multidrug and toxin extrusion (MATE) transporters play significant roles in the renal secretion of organic cations and drug–drug interactions (DDIs). Recent in ...

💊 Authors' recommendation for CKD 4-5:

For anionic drugs (OAT1/3) with high secretory contribution → consider an additional 50% reduction in secretory clearance beyond GFR-based adjustment

📄 doi.org/10.1002/cpt....
📄 doi.org/10.1002/cpt....

Clinical Implications of Altered Drug Transporter Abundance/Function and PBPK Modeling in Specific Populations: An ITC Perspective The role of membrane transporters on pharmacokinetics (PKs), drug–drug interactions (DDIs), pharmacodynamics (PDs), and toxicity of drugs has been broadly recognized. However, our knowledge of modula....

📊 OAT1/3 substrates (anionic drugs) in severe CKD:
→ Fx = 0.50 ± 0.29, CV = 58%
→ Penicillins, methotrexate, tenofovir

OCT2/MATE substrates (cationic drugs):
→ Fx ≈ 1.0 (range 0.77–1.13)
→ Metformin, amantadine, trimethoprim

Anions are unpredictable, cations follow GFR 🎯
📄 doi.org/10.1002/cpt....

A secondary analysis of the TESTING trial predicted individual patient response to corticosteroid treatment in IgA nephropathy Corticosteroids are effective for treating IgA nephropathy but have important adverse effects. In this secondary analysis of the TESTING cohort, we generated a model to predicts, for an individual pat...

interesting post hoc analysis from TESTING trying to identify which patients might benefit from steroids in IgAN

(esp useful for markets where thats all we have!)

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

#NephSky

Tell us why YOU pay attention to public policy or what you wish you knew!
My 2026 resolution is to better educate myself about healthcare policy. @robertblaser.bsky.social @garysinger.bsky.social

Potential confounders in studies identifying associations between plasma sodium correction rates and mortality. Na = sodium, AVP = arginine vasopressin A) A perceived causal relationship between an exposure and an outcome can be distorted by a third variable, known as a confounder. B) The serum sodium correction rate is the exposure, mortality is the outcome, and certain comorbidities and their severity act as confounders influencing both variables. C) Advanced stages cirrhosis, heart failure, and cancer are linked to higher mortality risk, sustained AVP release, and reduced kidney function, leading to impaired water excretion and slow serum sodium correction. D) In early stages of these conditions—or in their absence—patients exhibit better survival and, because hyponatremia is usually the result of reversible conditions with relatively preserved kidney function, serum sodium can rise rapidly through large-volume water diuresis.

Perspective by Richard H. Sterns and Helbert Rondon-Berrios:

Revisiting New Data on the Mortality Benefit of Rapid Correction of Hyponatremia: Déjà vu All Over Again

bit.ly/42Sl41K

Call for routine high blood pressure testing of UK children as cases almost double Exclusive: Identifying teenagers at risk could help prevent organ damage, strokes and heart attacks in early adulthood, doctors say

Call for routine high blood pressure testing of UK children as cases almost double
www.theguardian.com/society/2026...

Woman, 71 yo, allopurinol user, U-Sed: Uric acid crystals.

*First time I've seen crystals; How beautiful these crystals are! 😍 can't imagine how excited I am. Maybe only a few will understand 🤭 Happy New Year 2026! May there be more urinary sediments to explore

#urinarysediment #urinarymicroscopy

Nephrotic syndrome genomic discovery in the Mass General Brigham Biobank identifies monoallelic MEFV variants as a risk factor for focal segmental glomerulosclerosis Health system-based biobanks with genetic data provide a unique opportunity for nephrotic syndrome (NS) genomic discovery. This is predicated on finding cases in the electronic-health-record.

Nephrotic syndrome genomic discovery in the Mass General Brigham Biobank identifies monoallelic MEFV variants as a risk factor for focal segmental glomerulosclerosis
#nephsky #nephrology
www.kidney-international.org/article/S008...

🧵11/11
Source: Joshi A, et al. Sjögren's syndrome and hepatitis C virus infection presenting as hypokalemic quadriparesis: A case report. Journal of International Medical Research 2025;53(12):1-8. DOI: 10.1177/03000605251404767

🧵10/11
KEY LESSONS 🎯:
1. Consider autoimmune diseases (especially Sjögren's) in refractory hypokalemia + distal RTA
2. Sicca symptoms may be subtle - ask specifically about them!
3. HCV can mimic Sjögren's - check viral load
4. Early diagnosis + electrolyte correction = rapid recovery

CASE REPORT: Hypokalemic Quadriparesis for Nephrologist

A woman in her mid-20s presented to the ER with sudden-onset weakness in all limbs, unable to stand from sitting position. She'd had lower abdominal pain, vomiting & leg muscle pain for one week.
What was causing this dramatic presentation? 🧵

Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of kidney failure. This #ASNJASN study developed a multivariable predictive model for progression to kidney failure: kidney.pub/JASN0950 @alanyuneph.bsky.social

FF 87 Can Fish Oil Knock the Crap out of Dialysis Associated CV Disease? — NephJC FF 87 Can Fish Oil Knock the Crap out of Dialysis Associated CV Disease?

Freely Filtered #87: Can Fish Oil Knock the Crap out of Dialysis Associated CV Disease? We tried to find a problem with PISCES and came up with an empty net.

Time to get your supplements on for your dialysis patients!

www.nephjc.com/freelyfilter...

A must read comprehensive article @ndt-era.bsky.social focusing on the biology/genetics of kidney stone. It highlights GWASs of calcium and phosphate handling (e.g., SLC34A1, CYP24A1, CaSR) and crystallization inhibitors (e.g., UMOD, pyrophosphate-related genes).
academic.oup.com/ndt/article-...

go home pharma, you’re drunk