Well deserved Cristina and Brian!

Don't think we won't hound u @hswapnil.medsky.social @kidneyboy.bsky.social ! 😉

How will it differ from target rx of TRF- budesonide. Does TRF budesonide decrease APRIL /BAFF?

Which will have a better adverse effect profile in terms of increased risk of mucosal infections? #NephJc

Is it proteinuria or albuminuria? OR both?

This trial did albuminuria evaluation separately from proteinuria...are we moving towards albuminuria for all ( including GN) #NephJC

Look at that eGFR slope..so close to baseline and often above it ! #NephJC

Doesn't this prevent B cell activation and antibody production against other infections?

The phase 2b had a clause that all patients should have received age appropriate vaccinations, but no mention of vaccination status in phase 3 as far as i cud understand #NephJC

Shouldn't there be a clause at the beginning of the trial? that they must make it available in countries where the trial participants were there? #NephJC

In their defense- it's not the supplement, it's the protocol- and of both phases of the trial

The supplement is just 12 pages #NephJC

Hence the new drugs... let's see how they pan out in the future..#NephJc

Is going to be difficult to have a trial to support this...

To prove the difference between the two groups will need a long follow up and huge N coz only the first 3 m will be different

We don't have an trials supporting RASi and flozin started simultaneously, but we still do it.

#NephJC

Most interesting part of the guideline is this table supporting SIMULTANEOUS start of RASi/flozin WITH Nefecon/Steroids.
No waiting period for "optimal supportive care".
Seems a little difficult to swallow initially but doesn't that make perfect sense since it's an immune-mediated disease #NephJC?

Yes #NephJC

Should we stop RASi at time of gross hematuria, anticipating an AKI? Frankly very few patients in India present with gross hematuria and don't have much experience with them #NephJC

Came here to say this. I have also felt that monthly cyclo doesnt work well them, CYCLOPS 2 weekly regimen is better- but infections 😭 #NephJC

No no, the genital mycotic infections haven't been commented on in the @kdigo.org guideline.

It's just a thought to look our for it when giving flozins with IS.
#NephJC

4 tools now,
At time of diagnosis
Post bx tool (can be used at 1,2 years)
Pediatric tool
Post bx pediatric tool.

I did a @glomcon.org blog on it long back (everything in IgAN seems ancient due to breakneck speed of research) #NephJC
pubs.glomcon.org/internationa...

Agree, low threshold. Till now we used to bx at UPCR 0.5 only in suspected Lupus nephritis or if active sediment.
All others with >1 g .
This could be practice changing
But m wondering if we would end up doing bx in urological causes as well #NephJC

Fewer side effects definitely, not sure about efficacy being superior to systemic steroids #NephJC

I believe everyone does that across the globe till now. All immune drugs are approved only on background RASi

Till IgA guidelines 2025 talked about simultaneous treatment , let's see if this can change our practice #NephJC