Freely Filtered, a NephJC Podcast

NephJC
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Freely Filtered, a NephJC Podcast

Twice monthly (aspirational) recap of the NephJC journal club. NephJC reviews the most important manuscripts which are driving nephrology forward and improving our understanding of the kidney.

  1. 18 OCT

    FF 74: Amino Acids for AKI

    The Filtrate: Jennie Lin Joel Topf Josh Waitzman Swapnil Hiremath With Special Guests Pedro Teixeira Jay Koyner Editor Sophia Ambruso Show Notes The article: A Randomized Trial of Intravenous Amino Acids for Kidney Protection NephJC Summary KDIGO Clinical Practice Guideline for Acute Kidney Injury (PDF) Steve Coca study Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials (PubMed) Using Nephrocheck to prevent AKI: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial (PubMed) Brenner’s Review of protein intake and renal hemodynamics: Dietary Protein Intake and the Progressive Nature of Kidney Disease: — The Role of Hemodynamically Mediated Glomerular Injury in the Pathogenesis of Progressive Glomerular Sclerosis in Aging, Renal Ablation, and Intrinsic Renal Disease (NEJM) Husain-Syed a look at preoperative renal functional reserve and risk of AKI: Preoperative Renal Functional Reserve Predicts Risk of Acute Kidney Injury After Cardiac Operation (PubMed) Dana Fuhrman review of renal functional reserve: The Role of Renal Functional Reserve in Predicting Acute Kidney Injury (PubMed) Use of SGLT2i prevented AKI in the placebo controlled trials. Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals (PubMed) Assessment of P values for demographic data in randomized controlled trials (PubMed) Tubular Secretions Swapnil The Lord of the Rings: Rings of Power Season 2 on Amazon Prime (Wikipedia) Josh Fortnite (Website) Pedro CRRT Academy at University of Alabama Birmingham (Website) Jay Koyner Slow Horses on AppleTV (Wikipedia) Jennie Linn #KidneyWk Run Club Friday 10/25 at 6:15 am PST Meet in front of Sally’s Fish House ~2 miles. Easy pace (10-12 min/mile) (Strava) Joel Topf Your Honor on Netflix (Wikipedia)

    1 h y 33 min

  2. 1 AGO

    FF 73: The KDIGO 2024 CKD Guideline Draft

    The draft order: Sophia Ambruso Nayan Arora Swapnil Hiremath AC Gomez Joel Topf Editor Nayan Arora Show Notes Previous drafts: 2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh 2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie 2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan 2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan 2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh 2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, AC The guideline The NephJC discussion Part 1 | Part 2 First Round Sophia’s Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A). Not Nayan’s Pick 3.7.3: We suggest treating adults with eGFR 20 to 45 ml/min per 1.73 m2 with urine ACR 10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations. Practice Point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for kidney replacement therapy (KRT) including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations. Swap’s Pick 3.15.1.1: In adults aged ‡50 years with eGFR 1.3 g/kg body weight/d) in adults with CKD at risk of progression. 3.3.1.2: In adults with CKD who are willing and able, and who are at risk of kidney failure, consider prescribing, under close supervision, a very low–protein diet (0.3–0.4 g/kg body weight/d) supplemented with essential amino acids or ketoacid analogs (up to 0.6 g/kg body weight/d). 3.3.1.3: Do not prescribe low- or very low–protein diets in metabolically unstable people with CKD. AC’s Pick 3.9.1: In adults with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA (1B). Swapnil’s Pick Practice Point 5.4.1: Initiate dialysis based on a composite assessment of a person’s symptoms, signs, QoL, preferences, level of GFR, and laboratory abnormalities. IDEAL Trial: A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis NEJM Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study NephJC Nayan’s Pick Practice Point 1.1.4.2: Use tests to establish a cause based on resources available (Table 6b). Sophia’s Pick Practice Point 1.1.1.2: Following incidental detection of elevated urinary albumin-to-creatinine ratio (ACR), hematuria, or low estimated GFR (eGFR), repeat tests to confirm presence of CKD. Joel’s cystatin C Tweet The cystatin C guideline recommendation 1.1.2.1: In adults at risk for CKD, we recommend using creatinine-based estimated glomerular filtration rate (eGFRcr). If cystatin C is available, the GFR category should be estimated from the combination of creatinine and cystatin C (creatinine and cystatin C– based estimated glomerular filtration rate [eGFRcr-cys]) (1B). Nayan’s additional thoughts. He is not a fan of Practice Points 3.6.4 and 3.6.5 Practice Point 3.6.4 Continue ACEi or ARB therapy unless serum creatinine rises by more than 30% within 4 weeks following initiation of treatment or an increase in dose. and Practice Point 3.6.5: Consider reducing the dose or discontinuing ACEi or ARB in the setting of either symptomatic hypotension or uncontrolled hyperkalemia despite medical treatment, or to reduce uremic symptoms while treating kidney failure (estimated glomerular filtration rate [eGFR] 15 ml/min per 1.73 m2). Tubular Secretion Swap The Murderbot Diaries by Martha Wells Nayan Searching for Hobey Baker Narrated by David Duchovny AC Rosie Revere, Engineer Sophia Bassnectar How to fix the Apple Music automatically playing when you connect to bluetooth. Joel T

    1 h y 32 min

  3. 15 JUN

    FF 72: Nefecon for IgAN, The NefIgArd part B trial

    Nefecon, coated budesonide, is the first drug labelled for IgA nephropathy and the approval path, 9-month reduction in proteinuria followed by 2 year GFR data set the stage for the GN renaissance we are currently living through.

    1 h y 32 min

  4. 1 JUN

    FF 71: Semaglutide for diabetic nephropathy FLOW

    On May 24th, at the ERA meeting in Stockholm Sweden (this will not be the last GLP1ra talk at Stockholm), Vlado Perkovic presented the previously spoiled results of FLOW. In addition to simultaneous publication in the NEJM, it made the front page in newspapers around the world. As one headline writer said, “Is there anything Ozempic can’t do?”

    1 h y 24 min

  5. 26 MAY

    FF 70: The PRAECIS trial, predicting severe preeclampsia

    Nothing terrifies nephrologists, quite like the consult from labor and delivery. And one of the most vexing questions is, “Is this preeclampsia or proteinuric CKD or a lupus flare?” Perhaps a newly approved blood test will be able to shed light on this clinical conundrum. The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) has appeared predictive of severe preeclampsia. The PRAECIS trial evaluated this is a prospective manner. Join the filtrate as we do a truly incompetent job discussing this study.

    1 h y 16 min

  6. 22 ABR

    FF 69:DUPLEX Sparsentan, it’s no Acthar Gel

    FSGS is hard and the data sucks. But here comes sparsentan fresh off its win in the PROTECT trial for IgA Nephropathy. Can it pull another rabbit out of the hat for patients that suffer from FSGS or are we doomed to forever treating our patients with Acthar® Gel?

    1 h y 42 min

  7. 16 MAR

    FF 68: Inpatient hypertension

    Beep Beep. Hey intern the patient’s blood pressure is 160/95. Do you want to do something. No. The answer is no. But honestly we have all been guilted into ordering some clonidine or god forbid some IV hydralazine. Stop it. Just stop it. Join the filtrate as we dissect a recent study looking at this issue with the lead author.

    1 h y 28 min

  8. 7 MAR

    FF67: NephMadness Animal House

    NephMadness prides itself on not repeating topics. Most topics don’t get revisited for years after a single appearance. But one region stands alone. One region is making its fourth appearance in the 12 year history of NephMadness! That region is Animal House! Modern medical education doesn’t go to the comparative physiology well very often. So when we do, it is always fresh and exciting. Join the Filtrate as we explore the fascinating world of the Gila Monster and Mourning Dove.

    48 min
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Twice monthly (aspirational) recap of the NephJC journal club. NephJC reviews the most important manuscripts which are driving nephrology forward and improving our understanding of the kidney.

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