Niranjan Ganesh

The dramatic expansion in CKD therapeutics to prevent progression of kidney disease and reduce cardiovascular events calls for thoughtful implementation. The 2025 guidelines synthesize new evidence for Primary Care Management of CKD in this #ASNCJASN #perspective kidney.pub/CJASN1018

A Young Man With Nephrotic Syndrome and Facial Rash: A Quiz bit.ly/4cefbQu (FREE) •What further tests are needed to determine the etiology of the rash? •What additional tests can be done? •How would you treat this patient?

Approach to Failing Kidney Allograft 🧠🩺 1️⃣ Define early Falling graft = ↓eGFR, ↑proteinuria, DSA ± 👉 Prevent crash dialysis & sensitization 2️⃣ Find the cause (KEY = biopsy) Rejection (AMR/TCMR) CNI toxicity BK / infection Recurrent GN 3️⃣ Parallel strategy ✔ Treat reversible causes ✔ Start retransplant workup (eGFR <20) 4️⃣ Immunosuppression dilemma Retransplant candidate → continue low-dose IS Not candidate → taper 👉 Balance sensitization vs infection 5️⃣ CKD care matters Anemia, MBD, acidosis, BP, nutrition 6️⃣ Dialysis timing 👉 Symptom-based (no fixed eGFR) 👉 Avoid crash start 7️⃣ Nephrectomy? Only if: Graft intolerance Infection Severe rejection 8️⃣ Best outcome = Pre-emptive retransplant 🏆 ⚠️ Biggest mistake: Late referral ⚠️ Most neglected: CKD care #GSR #BuddingNephros #Transplant

New Clinical Nephrology Insights in #ASNJASN highlights that living kidney donor evaluation is evolving, with updated guidelines and tools reshaping who qualifies and how risks are assessed. kidney.pub/JASN1082

💥 Discover this interesting chapter selected from the ERA Neph-Manual: Acute tubulo-interstitial nephritis. 🔎 This chapter explores acute interstitial nephritis as a common cause of acute kidney injury, focusing on its causes (especially drugs), non-specific presentation, diagnostic challenges requiring biopsy, and treatment through drug withdrawal and early steroid use. Don't forget to test your knowledge 👉 bit.ly/3OhFmxx

nejm.org/doi/full/10.10… REVIEW ARTICLE 1 April 26 @NEJM GLP-1 Receptor Agonists

GLP-1 receptor agonists are increasingly used to treat type 2 diabetes and obesity, and trials have shown reductions in cardiovascular risk and slowing of kidney failure. Adverse events are mostly gastrointestinal. Read the Review Article “GLP-1 Receptor Agonists” by Clifford J. Rosen, MD, and Julie R. Ingelfinger, MD, from @tuftsmedschool and the Maine Medical Center Institute for Research: nejm.org/doi/full/10.10…

#WATCH | Jaisalmer, Rajasthan: The Desert National Park (DNP), located in Jaisalmer, is currently witnessing a significant congregation of raptors. This includes several species—most notably the Steppe Eagle—that are on the verge of extinction.

Important review on weight Weight Regain and Cardiometabolic Consequences After Discontinuation of GLP-1 Receptor Agonists GLP-1RA discontinuation should be considered a high-risk clinical transition rather than a treatment endpoint. Structured follow-up and multidisciplinary management are essential to preserve long-term cardiometabolic benefits. dom-pubs.onlinelibrary.wiley.com/doi/full/10.11…

In May 2019, FDA identified 82 completed suicides linked to montelukast, many with preceding neuropsychiatric symptoms. Reports span adults and children. Prompted by this, In march 2020 FDA issued a prominent boxed warning for serious neuropsychiatric events. These can include suicidal thoughts or actions, agitation, aggression, anxiety, depression, hallucinations, insomnia, vivid nightmares, sleepwalking, irritability, memory issues and obsessive-compulsive symptoms and suicidal ideations/behaviours. These can affect all ages, with or without psychiatric history, and may occur during use, after stopping, or rarely persist. In contrast, RCTs and meta-analyses typically show no major increase versus placebo, though some note modest rises in anxiety and sleep problems. Recent large cohort studies (e.g., Swedish pediatric data) often find no significant risk elevation compared to other asthma therapies. Causality remains debated due to confounding (asthma/allergies themselves link to mood/sleep issues) and detection challenges for rare events. The FDA notes animal data showing montelukast crosses the blood-brain barrier, supporting biological plausibility. While overall incidence is low, events can be severe. The FDA advises close monitoring, patient/caregiver education on symptoms, and prompt discontinuation if issues arise.

A high-level clinical roadmap designed to help healthcare professionals diagnose and manage common electrolyte imbalances. It breaks down complex physiological processes into logical flowcharts based on lab values and clinical signs. @DharSaty

Extrarenal Disease in ANCA-Associated Vasculitis: Challenges and Evolving Therapeutic Strategies on behalf of the Immunonephrology Working Group (IWG) of the ERA academic.oup.com/ndt/article-ab…

American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults With Type 2 Diabetes – 2026 Update This 2026 update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and T2D. It also provides guidance on the management of atherosclerotic risk factors of dyslipidemia and hypertension #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @DrMarthaGulati @hvanspall @CMichaelGibson @ankeetbhatt @cardioceptor @Hragy @SubodhVermaMD @vuralmg @AshuNephro endocrinepractice.org/article/S1530-…

📊 JAMA Clinical Guidelines Synopsis: The 2024 guideline from the @American_Heart and @ACCinTouch recommends continuing statins and β-blockers for patients undergoing noncardiac surgery. ja.ma/3NDhhRE

Free to Be in Peritoneal Dialysis: Without Kt/V? bit.ly/49Wyf4t (OPEN ACCESS) @IMWendyYe @JoanneBargman @PD_Perls

Alport :early 🧬 #ISNWCN

Anemia 2026

Retroperitoneal fibrosis is a rare immune-mediated disease which can be classified as idiopathic or secondary. A new Seminar provides an overview of retroperitoneal fibrosis focusing on pathophysiology, differential diagnosis, and management: spkl.io/6010AFXEE

📊 JAMA Clinical Guidelines Synopsis: The 2025 guideline for #ACS management recommends dual antiplatelet therapy with aspirin and a P2Y12 inhibitor, high-intensity statins, invasive revascularization, and radial access for angiography. ja.ma/4dc0QpH

Rituximab dosing and management for Nephrotic syndrome .