Deb Choudhury

Several acanthocytes, under darkfield illumination - from patient with MPA - #UrineMicroscopy #UrinarySediment

🩻Contrast-induced AKI: one of the biggest myths still shaping clinical decisions For decades we were taught: 👉 “Contrast damages the kidneys” 👉 “Avoid CT with contrast in CKD” 👉 “Hydrate, protect, delay imaging if needed” But what if… most of this is wrong?🤔 ->The uncomfortable reality Modern evidence shows: 👉 Low-osmolar contrast rarely causes true nephrotoxicity 👉 Even in CKD, AKI, and ICU patients 👉 The risk is often overestimated—or nonexistent So where did the fear come from? 📍 1950s high-osmolar contrast (actually toxic) 📍 Poorly controlled observational studies 📍 “Creatinine rise = contrast injury” assumption 👉 Correlation became causation 👉 And the dogma stayed ⚠️What recent data tells us ✔ No difference in AKI rates with vs without contrast ✔ No benefit from bicarbonate, NAC, or aggressive hydration ✔ Even ICU and AKI patients show no worsening outcomes ->Translation to real life 👉 The patient was going to develop AKI anyway...Not because of contrast!! ->The real problem: “Renalism” 👉 Avoiding necessary imaging 👉 Delaying diagnosis 👉 Choosing inferior tests And that leads to: ❌ Missed PE ❌ Delayed sepsis source control ❌ Worse outcomes ->Clinical mindset shift Instead of asking: 👉 “Will contrast harm the kidneys?” We should ask: 👉 “Will NOT doing the scan harm the patient?” ->Who still deserves caution? ✔ eGFR <30 ✔ Severe hemodynamic instability ✔ Multiple nephrotoxins Even then: 👉 Optimize volume 👉 Minimize dose 👉 Don’t delay critical imaging 🤓Bottom line ✔ Contrast nephrotoxicity exists… but is rare ✔ The fear is bigger than the risk ✔ The harm of NOT imaging is often greater In critical care 👉 We don’t treat creatinine 👉 We treat patients And sometimes… 👉 The most dangerous thing is NOT the contrast 👉 It’s hesitation. 📃Reference Florens N, Demiselle J. Kidney360 7: 445–449, 2026. doi: doi.org/10.34067/KID.0…

🔦Distinguishing IgA nephropathy (IgAN) vs PGNMID (IgA λ) can be tricky. IgAN often shows λ predominance on IF, but λ ≠ monoclonality. 🔬 IgAN: polyclonal (λ > κ, BOTH present, similar distribution)
🔬 PGNMID: monotypic (λ only, κ absent/trace) Correlate with morphology: •IgAN → mesangial deposits (EM), mesangial proliferative (LM) •PGNMID → subendothelial ± subepithelial deposits + MPGN/endocapillary pattern ⚠️ Serum monoclonal IgA λ ≠ PGNMID (can have MGUS + IgAN) 🧠 Bottom line:
λ predominance = physiologic (IgAN)
λ restriction = pathologic (PGNMID) Always integrate IF + EM + LM + clinical context 📚 Nasr JASN 2009 | Sethi KI 2010 | KDIGO 2021 #RenalPath #Nephrology #MedEd @MayoClinicPath @Renalpathsoc

When eGFR drops after initiating treatment with empagliflozin or finerenone, we often stop these treatments. This is less likely to happen when eGFR is already low. The initial eGFR drop associates w/ diuretic use. Back off on the diuretics, not the disease modifying therapies.

IgA nephropathy progresses to kidney failure in up to 50% of patients within 10–20 years. On March 29th, the NEJM published the final 24-month data from APPLAUSE-IgAN and the results change the treatment landscape. Here’s what every nephrologist needs to know 🧵 Barratt J et al. NEJM 2026. DOI: 10.1056/NEJMoa2600743

Guide wire width in inches Needle width in gauge Catheter width in French And length of all three in cm Can we just use one system of units?

#CNSICON2026 communion of Nephrologist-critical care specialist on a single platform 🔥 400 plus attendees 👉 overcrowded sessions #VExUS #CRRT #POCUS workshops ⭐️Networking✅industry, stalwarts 🥂Gala night #AleenaBharti 💥Multiple Panels #DTGames2026 🥂👉All👈@ShreshtaT

Simple concept: Fibrinoid necrosis (necrotizing glomerulonephritis) versus Fibrin thrombi (thrombotic microangiopathy, TMA) 1. In fibrinoid necrosis, there is breach/rupture of the glomerular basement membrane (GBM), & fibrin is present in the Bowman’s space. Top panel. 2. In fibrin thrombi, the glomerular basement membrane is INTACT. There is No rupture of the GBM. Fibrin is present within glomerular capillary, and not in Bowman’s space. Bottom panel

@GlassockJ NAC interferes with enzymatic reaction to reduce creatinine - but no effect if you check it with Jaffe It’s all an artifact

Renal blood flow... instagram.com/p/DV1DDrejWWw/…

QT-prolonging medications: prevalence of use and associated risks in CKD doi.org/10.1093/ndt/gf…

Sachin Tendulkar is still a go to person for this generation. Rahul Dravid had enough time for the U19s to coach them, VVS Laxman is looking after the next generation. It is people like these, and those that seek them out, that make for a strong system.

Here is today’s #eyeSCANdy! Acellular scanning EM of a normal glomerular tuft showing the subpodcocytic capillary loop basement membranes following removal of the podocytes.  Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

The management of high blood pressure is moving towards an injectable drug twice a year instead of daily pills. Multiple late stage clinical trials in progress thelancet.com/journals/lance…

Access recirculation is primarily a technical issue, not a machine setting problem. Correct catheter connections, appropriate needle direction and spacing, and early identification of access stenosis are essential to ensure delivered dialysis matches the prescription.

Let's kick off 2026 with a review article on cardiogenic shock. When families ask, "Why are they so sick when it is just their heart?" provide them with this image. 🎩 tip to the authors. eddyjoemd.com/foamed

Spotted by Dr. Singh! A KW nodule measuring 204.65 um in diameter in a case of diabetic nephropathy. #worlddiabetesmonth #renal #kidneypath #nephtwitter

OK nephrologists: pickles/juice has a pH of 3.0. How many H+ (in mmols) will I be ingesting if I eat this entire 100 ml container of super acid pickles. Also how many mmol of Na will I be ingesting? Show the math. Don't get sucker punched on this one.

💥Is there an entity called “Fatty Kidney Disease” ⁉️ ⚡️Can kidneys too be obese? Yes indeed ‼️ #NephroNotes #NephPearls #FOAMEd #MedEd

Review by Rochella A. Ostrowski: Gout Management in Patients With CKD: A Review bit.ly/49b9x1o