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Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

the USRDS here

absolute numbers quite small (cc @spjuraschek.bsky.social ) though age categories slightly different)

November 26, 2025 at 6:33 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

A VP at Campbell (maker of the famous soups) caught saying the quiet part aloud

apple.news/A5veRPLn-Sne... (WSJ, apple news link)

https://apple.news/A5veRPLn-SneDaHWxWRGAMw

Garza said Bally called Campbell’s food highly processed and said it was for poor people. Garza also accused Bally of disparaging Indian co-workers, calling them “idiots,” and saying he didn’t like working with them.

November 26, 2025 at 10:11 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

That was quick!

The US FDA approves Sibeprenlimab aka Voyxact for reducing proteinuria in IgA

www.fda.gov/drugs/novel-...

#NephSky

#TopNephrology

November 26, 2025 at 12:21 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

I did not know it was this bad

Look at the mortality in younger females (versus males) in CKD 5

jamanetwork.com/journals/jam... in @jamainternalmed.com from Alberta

#NephSky #GenderDisparities

Figure 2. Standardized Mortality Ratio and Female to Male Mortality Rate Ratio

November 25, 2025 at 7:14 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

The ongoing decline in dialysis incidence in the US

usrds-adr.niddk.nih.gov/2024/end-sta...

#TopNephrology

November 24, 2025 at 10:38 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

The NIDDK turns 75 diabetesjournals.org/care/collect...

Just as with restructuring they cannot even update the website www.niddk.nih.gov

#TopNephrology

November 24, 2025 at 10:37 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

“Nurses should take over’

Amen.

Excerpt from the New Yorker essay by Tatiana Schlossberg

www.newyorker.com/culture/the-...

#MedSky

The nurses brought me warm blankets and let me sit on the floor of the skyway with my son, even though I wasn’t supposed to leave my room. They ate up the gossip that I gathered; they looked the other way when they saw that I had a contraband teakettle and toaster. They told me about their kids and their dating lives and their first trips to Europe. I have never encountered a group of people who are more competent, more full of grace and empathy, more willing to serve others than nurses. Nurses should take over.

November 23, 2025 at 2:19 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

Throwback to a 2017 presentation by @juancarlosqvelez.bsky.social where he deconstructed the IAC definition

What do you think of the albumin criteria JC?

#NephSky #EMIMCC

November 23, 2025 at 2:06 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

Another interesting @kidneyint.bsky.social cohort study

www.kidney-international.org/article/S008...

Infection risk in kidney disease - lupus > ANCA, perhaps as ANCA is one and done (usually) whereas #lupus is never done?

Lupus > other primary and ADPKD is not surprising

#NephSky

November 23, 2025 at 1:53 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

And also the top in 2011
(Read the comments here www.renalfellow.org/2011/12/25/t...)

#TopNephrology

November 21, 2025 at 12:01 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

The top position in 2017

$1. SuPAR and APOL1 in Nature Medicine (50%)- SuPAR is #1, the suPAR enthusiasts come out in force with the heavy voting and it is not a surprise as suPAR has been a consistent story for the last eight years. Last year, it hit the number 1 spot with a basic science paper published in Nature Medicine. In 2011, suPAR was ranked #1 TopNephrology stories with the original Nature Medicine paper describing its potential link to FSGS. In 2015 suPAR landed at number 14 with the NEJM paper linking suPAR to CKD in a cohort of patients at Emory undergoing cardiac catheterization. The current study looked at the association between suPAR, Apolipoprotein L1 (APOL1) risk variants, and eGFR decline in two separate cohorts of individuals of African ancestry. It was found that plasma suPAR levels independently predict renal function decline in individuals with two copies of APOL1 risk variants. They also explored the possibility of a protein–protein interaction between suPAR, APOL1 and αvβ3 integrin and showed that the G1 and G2 risk variants of APOL1, but not the reference protein G0, synergize with suPAR in the activation of αvβ3 integrin on podocyte. This binding causes change in structure and function, allowing disease onset. Using cell models and genetically engineered mice, the authors reproduced kidney disease changes upon expression of APOL1 gene variants, but the disease required the presence of (high level) suPAR. African Americans have a higher rate of kidney failure than any other group of people. In fact African Americans are four to five times more likely to have kidney failure then Americans of European descent. The discovery of the genetic variants in the APOL1 gene along with the findings of this study may explain a large fraction of this major health disparity.$

November 21, 2025 at 12:01 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

And in 2018!

7: SuPAR predicts Kidney badness

suPAR is to #TopNephrology countdowns as Vertigo is to “Best Movies Ever” lists; it’s always there.

I like to think of suPAR as nephrology’s Odysseus. Many of us probably first met our doughty hero during his exertions in the Trojan War, establishing various lines of evidence that he might be the permeability factor in FSGS. But since then, his wandering return to Ithaca has taken in many fresh tales and challenges. Whereas Odysseus travelled to the underworld, met Cyclops, the Lotus Eaters, and Circe, skirted the land of the Sirens and passed between Scylla and Charybdis, suPAR has been associated with incident CKD, and a declining eGFR, predicted CKD in African Americans regardless of APOL1 genotype, predicted mortality in African Americans with T2DM, and mortality in dialysis patients, and finally been suggested as a better marker of infection than CRP in AKI.

So will 2019 see suPAR return to slay the suitors to the permeability factor crown? I am not sure but no doubt you’ll be able to read all about suPAR in #TopNephrology 2019.

November 21, 2025 at 12:01 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

It has made several appearances on #TopNephrology!

2020 (2nd position)

SuPAR predicts AKI in COVID-19

With apologies to AA Milne

When suPAR was one,

It had just begun.

Telling us all that FSGS was won.

When it was two,

It was nearly new.

And lucky for us, was explaining CKD too.

When I was three,

I was hardly me.

Because now I was predicting mortality in diabetes you see.

When I was four,

I was not much more.

But predicted mortality in dialysis patients for sure.

When I was five,

I was just alive;

I was implicated in AKI, and therefore my use could thrive.

But now I am six,

I'm as clever as clever.

Because I predict AKI in Covid-19 infection,

And that’s going to be around for ever and ever

So I think I'll be six now.

At least until Top Nephrology Stories 2021.

November 21, 2025 at 12:01 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

From the figure one wonders of effect modification (by age) in particular

The younger primary GN are much much worse than even younger DKD

ADPKD is the same (young or old)

Any other thoughts?

@christosargyrop.bsky.social

3/3

Figure 2 Modelled individual and mean eGFR slopes by disease etiology, age, and sex over 6.5 years follow-up. Footnote/abbreviations: m: male, f: female, ADPKD: autosomal dominant polycystic kidney disease, eGFR: estimated glomerular filtration rate. Modelled eGFR values as derived from Model 3 for all participants after 6.5 years of follow-up by disease etiology, sex, and age group. Age subgroups are separated at the median age of 63 years. Upper panels: modelled eGFR slope for each participant (thin grey lines in the background) within the different disease etiology subgroups (A)-(E). Thick lines represent mean slopes within each disease etiology for age (solid line: < 63years vs dotted lines ≥ 63years) and for sex (male: blue, red: female). Modelled eGFR values below zero are treated as missing. Lower panels: Lines show individual examples of modelled eGFR slopes with the observed values (dots) for each participant within the different disease etiology subgroups (F)-(J).

November 20, 2025 at 11:38 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

Unsurprising that
- more albuminuria is worse
- diabetic kidney disease is worse
But
- ADPKD just as bad as ACR >3000?
- primary GN better!

2/3

Figure 1 Forest plot of model coefficients that affect the intercept (baseline eGFR) and the eGFR slope. Footnote/abbreviations: In Model 2 the reference category includes: male sex, UACR (Urine Albumin-to-Creatinine Ratio) below 30mg/g and as disease etiology HKD (hypertensive kidney disease). Panel (A) shows the main effects of the model while panel (B) shows the interaction effects with time. The model intercept (𝜷𝟎=𝟖𝟕.𝟑𝟑, 95% CI [84.39; 90.27]) is not shown. See Table S3 for further model details. ADPKD: autosomal dominant polycystic kidney disease. Positive effects are marked with blue, negative with red.

November 20, 2025 at 11:38 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

Fascinating study from Germany of adding etiology as well to GFR and ACR while looking at GFR declines, in @kireports.bsky.social

Paper: www.kireports.org/article/S246...

VA

1/3

November 20, 2025 at 11:38 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

CBD for symptom relief

A phase 1B trial from Australia (and not performed by @turbodc.bsky.social !)

www.kireports.org/article/S246... in @kireports.bsky.social

7/12 could complete therapy and no control arm caveats

Figure 1 Mean difference between baseline and on-treatment ESASr-Renal domain scores

November 20, 2025 at 1:24 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

Urine crystals in a patient with Crohn’s

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

#NephSky

November 19, 2025 at 5:40 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

Excellent comparison of completed IgAN studies from today's @CSNSCN webinar from Kevin Yau

#NephSky

November 19, 2025 at 5:21 PM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

They did

Everyone was on a RASi (not a RAASi - no evidence yet for MRA in non DKD)

So Flozin/no Flozin subgroup is as you describe

#NephJC

November 19, 2025 at 2:42 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

swapnil hiremath
not a GN doctor
mostly use palliative therapies in IgA

#NephJC

November 19, 2025 at 2:01 AM

Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

The @uottawa.ca and @ottawahospital.on.ca celebrate the 25th anniversary of the Kidney Research Centre this Saturday

Join us at the open house if you are free!