Bryce Barr

Maybe I’m missing something in this, but why now? Aren’t these all concerns/issues that were readily apparent in 2021? (COI Otsuka)

The Topsy-Turvy approach to CVD in Kidney Transplant with Prof Adnan Sharif YouTube video by Ottawa Nephrology

No

Here’s @adnan-sharif.bsky.social making an eloquent case youtu.be/4l_1j24CdOg?...

The best treatment for CAD in a dialysis patient is a kidney transplant

#NephSky as a non-transplanter who watches patients wait months-years on dialysis for testing that is known to be unhelpful for perioperative risk reduction in the general population, is there any good justification for screening patients for CAD pre-transplant?

I find it extremely odd that the first sentence identifies PJP prophylaxis as a major indication for TMP/SMX, and the rest of the paper seems to completely ignore that. No mention of autoimmune disease in the tables, or the 84 variables used to calculate the propensity score

Certainly. I think that is a really important takeaway from this paper.

I do wonder what the results would look like in an incident LN population though. Younger, but more heavily immunosuppressed with a higher dose of GC. How would that compare to an age-matched patient with DKD?

Beyond Misinformation: Understanding and Coping with the“Post-Truth” EraStephan Lewandowsky∗University of Bristol, United KingdomUniversity of Western Australia, AustraliaUllrich K.H. EckerUniversity of Western Australia, AustraliaJohn CookGeorge Mason University, United StatesThe terms “post-truth” and “fake news” have become increasingly prevalent in public discourse over the last year.This article explores the growing abundance of misinformation, how it influences people, and how to counter it.We examine the ways in which misinformation can have an adverse impact on society. We summarize how peoplerespond to corrections of misinformation, and what kinds of corrections are most effective. We argue that to beeffective, scientific research into misinformation must be considered within a larger political, technological, andsocietal context. The post-truth world emerged as a result of societal mega-trends such as a decline in social capital,growing economic inequality, increased polariza

A little retrospective can be helpful at times to work out what has been happening and what was knowable. Let's travel back in time to 2017 (~8 years ago) when I was lead author on a paper about the post-truth world. doi.org/10.1016/j.ja...


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Interesting, thanks for sharing. I’ll need to read more about this registry, because the age of the patients is not consistent with other studies in LN and GN at all. I’m a bit surprised that doesn’t get mentioned.

This post is written in such an irresponsible way. He is not “determined to challenge scientific orthodoxy.” He is a moron, who knows nothing about the portfolio he oversees, who is forcing the CDC to publish blatantly false information, the consequence of which will be the death of many children.

The field owes her a great debt of gratitude in my opinion. Her talk at the ASN two years ago about this journey was fascinating. #NephJC

I think the best we can hope for (unfortunately) is that sponsors continue to shrink the immunosuppression washout period. Currently, my practice is to treat with the immunosuppression I have available to me (GCs), and if they still have >1g/d, enrol in an RCT as soon as the trial allows.

None. HC does not currently accept proteinuria or eGFR slope - this is being worked on. #NephJC

Yes, stable treatment effect, suggesting the benefit is additive.

Depending on the definition of recent, close race between Pitcher et al re: long term outcomes in IgAN and Watts et al re: the discovery of antibody-mediated podocytopathy (along with the confirmatory/supporting studies)

If my house is on fire, and my only option to put out the fire is to douse it in water, douse it in water. I dont like it but it’s the only disease modifying treatment available in many places (hopefully not for long). Also doesn’t need to be an “or”, I start the SGLT2 when I taper the pred. #NephJC

New insights into the biology and treatment of minimal... : Current Opinion in Nephrology and Hypertension sease and focal segmental glomerulosclerosis, there has been a transformation of our understanding of disease pathogenesis and treatment rationale. Recent findings Antinephrin antibodies are common...

It was a pleasure to collaborate with @kronbichlerlab.bsky.social and Dr. Astrid Weins on this article. We describe transformations in our understanding of podocytopathies, and novel treatment approaches in light of those advancements. journals.lww.com/co-nephrolhy...

Thanks Brendon. It’s something I wonder about given the proteinuria and eGFR curves in both TESTING and NefIgArd. And the MAIN trial for that matter, with its continuation vs withdrawal group. Data like that may help to inform what we do after someone completes a per-trial protocol treatment period

Really helpful insights Brendon.

I’m curious if the investigators have planned to analyze eGFR slope beginning after the treatment period? In particular, a single slope (no knot) with time zero at 9 months post-randomization to end of follow up? Would be helpful to evaluate the durability of GCs

I personally follow IgG levels every 3-6 months for patients on anti CD20 (at a minimum prior to the next dose of B cell depletion).

Impact of Glucocorticoid Dose on Complete Response, Serious Infections, and Mortality During the Initial Therapy of Lupus Nephritis: A Systematic Review and Meta-Analysis of the Control Arms of Random... A higher exposure to glucocorticoids during the initial therapy of LN was associated with better renal outcomes at the cost of increased infections and death.

Part of that could be the prednisone dosing. In LUNAR, started at 0.75mg/kg and tapered to <10mg/d at 16 weeks. Here started at 0.5mg/kg and tapered to <7.5mg/d at 12 weeks. Based on this meta analysis it makes sense that would increase infections. pubmed.ncbi.nlm.nih.gov/38766897/

Indigenous people in MB are probably overrepresented in our LN population based on our registry data, on a per capita basis

“Those nasty Canadians are ripping us off and are controlled by Mexican cartels. They’re poisoning us with fentanyl and need to become the 51st state or they will pay a high price” is a belief that literally ZERO Americans had six weeks ago. It’s entirely invented from scratch.

#askrenal Any tips for getting patients started on GLP-1 without debilitating nausea? Starting patients as per the FLOW protocol, counseling them that it could be temporary and to try to keep going, and I’ve only got a few still on treatment. What am I doing wrong? @hswapnil.medsky.social

I tell this to every single person! They’ve all heard of “anti-inflammatory diets,” etc and assume that if it’s possible to cure your AI disease as such, then the opposite behaviour gave them the AI disease. I see more relief when I tell people this than when I tell them they’re in remission.

Problem with RTX was it worked when it worked. But if not BCD, no increase in efficacy vs MMF alone. So this will be a more reliable alternative

I think that we’ve gained another tool that accomplishes both the goals of remission and steroid reduction. Extra renal dz drives up front choice IMO - none with nephrotic syndrome CNI, skin/joint BEL, really severe obi or CYC.

I think my preference would be to follow the trial protocol unless funding is a problem and I’m limited in the number of doses I can give

Only given obi a couple of times in PLA2R-MN, and both times the patient paid cash, so I gave one dose, checked CD19 at 4 weeks and both were CD19 =0, so no more. Both reached complete remission. In SLE the post hoc from LUNAR shows the importance of BCD, so I would follow every 3mo to 12mo I think

I should add that this trial extended beyond 12 months so gave 12 month doses which was not done in LUNAR, but the B cell depletion data at 12 months wouldn’t be affected by that.

It’s actually the mechanism of action - this is the same dosing schedule as LUNAR. NK cell function is reduced in SLE so ADCC with RTX is impaired. Fc region of obi is engineered to get around this problem. Only 50% had B cell depletion at 12 mo in LUNAR vs >90 here.

Need to factor in adherence, and presence/absence of extra-renal manifestations. CNI tough on adherence and minimal effect re extra renal disease. Obi is very attractive for that reason, and in my experience, even in severely proteinuric patients, one dose of obi = CD19 0. So could be cheaper.