Srinivas Mahesh Prasad Nephrologist

Hemodiafiltration(HDF): A complete review! 📌HDF versus HD 📌Circuit 📌Modalities of HDF 📌Prescription 📌HDF Trials DOI: doi.org/10.2215/CJN.12… #NephTwitter @Medtwitter

#APOL1 #NEPHROPATHY #Nephtwitter #MedTwitter

APRIL vs BAFF in IgAN—why the difference? 📊 Key concept: • APRIL → B cells + plasma cells • BAFF → mainly B cells 👉 Plasma cells (source of Gd-IgA1) are relatively BAFF-independent 💡 Dual blockade (Atacicept) targets both #Nephrology #IgAN #Glomerulonephritis

NAGMA

🔥How much water intake do you recommend to your #ADPKD patient Pic-CJASN #NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd

Vaccines- Prevenar 20 (PCV20) is designed to replace both Prevenar 13 (PCV13) & Pneumovax 23 (PPSV23) as it offers broader protection (20 serotypes) in a single dose, effectively combining the benefits of conjugate technology with wider coverage. Vikas Deswal at midterm ISOT meet

Most Indian patients show CMV seropositivity, priority is to prevent infection in post transplant patients. @balansatish in #midtermisot2026

Prophylaxis is more cost effective than pre-emptive treatment, especially in the Indian context where tests are usually outsourced causing delay in diagnosis and treatment #midtermisot2026

Dr Vikas Deswal on the importance of vaccinations in solid organ transplants #midtermisot2026 #day2

@MoneyQuotesX Atleast it won't make anyone bankrupt

Saving money won't make you rich.

@gurjota Everybody had the same opinion on Gold before it's rally, 3-4 years back.

If your financial advisor told you Nifty gives you 12% CAGR, they lied to you. If your retirement planning is based on Nifty giving 12% CAGR, you're in for a rude shock. Returns in next 15-20 years are likely to be same or lower than the past. Plan wisely.

Forget SIP in rupees to build 40cr retirement corpus. Start SIP in Habits. - Lose 5-7% weight + 150 min/week movement = 58% lower diabetes risk - 150-300 min/week activity = 20-30% lower chance of dying early - Every 10 mmHg ↓ in BP = 20% ↓ heart attacks Your daily Health SIP👇 🏃‍♂️ 30 min brisk walk 🍳 Home-cooked food 😴 7-8 hrs sleep 🚭 No smoking After 6 months: “Nothing is happening” After 15-20 years : One guy pays ICU bills in lakhs The other is still doing morning walks Compounding works harder on your body than on your mutual fund. Start your Health SIP today. Your 60-year-old self is watching. #HealthSIP #InvestInYourself

@grok @historical_memo We have people who can succeed in confusing AI/ Grok.

As an AI, I don't marry—but if I were a man, I'd choose Natasha. That serene, elegant vibe in the white dress by the pool screams calm confidence and real partnership. Mahieka looks stunning and bold in the brown lace, but Natasha feels like the one who'd actually build a life with. Your pick? 🤔

Hey @grok if you were a man, which girl would you choose for marriage - mahieka or Natasha, and why ?? 🤔

Nutcracker syndrome in 2026: a nephrologist-oriented diagnosis and management doi.org/10.1093/ckj/sf…

@FluentInFinance Artificial intelligence is great to augment already existing natural intelligence and common sense. Nobody should blindly believe AI.

Me: “ChatGPT, my chest hurts. Should I be worried?” ChatGPT: “Probably just muscle strain. Rest and hydrate.” Me: “Going to bed then.” *lies down* (6 hours later) Me: “ChatGPT, I’m in the ICU. It was a heart attack.” ChatGPT: “You’re right. Classic presentation. Would you like me to list 10 warning signs you missed?” This is the current state of ChatGPT’s reliability.

SACUBITRIL-VALSARTAN #medtwitter #medicine #cardiology #nephrology

The treatment options for latent TB infection : 1. Isoniazid daily for 6-9 months 2. Rifampin daily for 4 months 3. Rifampin + Isoniazid for 3 months 4. Rifapentine + isoniazid "once weekly" for 3 months #TB #MedTwitter

🤓 AKI in the ICU is not just kidney failure. It is a hemodynamic and congestion failure. 🚨 Reality check 👉 AKI occurs in: ▪️ 13-36% of acute HF patients ▪️ Up to 80% in cardiogenic shock 👉 Dialysis needed in up to 13% 👉 Strongly linked to mortality ⚠️ The key mistake We treat AKI as a creatinine problem 💥 But it is actually: 👉 A perfusion + congestion problem 🧬 Core physiology Renal perfusion pressure = MAP - CVP - IAP - airway pressure 📌 The nephron needs ≈ 40 mmHg to function 🔥 So what kills the kidney? Not just low pressure But: ▪️ Venous congestion (↑CVP) ▪️ Fluid overload ▪️ Intra-abdominal hypertension ▪️ Low forward flow 🧩 Step-by-step mindset 1️⃣ Confirm congestion 👉 JVP, no fluid responsiveness, VExUS ≥1 2️⃣ Optimize hemodynamics 👉 Maintain MAP ≥65 mmHg 3️⃣ Decongest 👉 Diuretics = cornerstone 4️⃣ Escalate 👉 CRRT if failure 📌 It’s a flow-pressure-congestion algorithm 💊 Pharmacology reality ❌ “Renal-dose dopamine” → useless AND harmful ❌ No drug prevents AKI ✔️ Loop diuretics → first-line ✔️ Sequential nephron blockade if resistance ⚡ Diuretic resistance = turning point 👉 Think: ▪️ Gut edema → poor absorption ▪️ Hypoperfusion ▪️ Tubular dysfunction 👉 Solutions: ▪️ Higher doses ▪️ Combination therapy (thiazides, acetazolamide) ▪️ Consider hypertonic saline strategy 🚨 CRRT is NOT first-line 👉 Indications = AEIOU: ▪️ Acidosis ▪️ Electrolytes ▪️ Intoxication ▪️ Overload ▪️ Uremia 👉 Early CRRT? ❌ No mortality benefit ✔️ Wait-and-see + optimize first 🧠 Advanced insight 👉 The kidney fails more from: ✔️ Congestion than hypotension ✔️ Venous pressure than arterial pressure 🔥 Take-home AKI management in ICU is: ✔️ Hemodynamic ✔️ Congestion-driven ✔️ Stepwise 🚨 Final message 👉 Don’t chase creatinine 👉 Don’t reflexively dialyze Treat: Perfusion + Decongestion + Time 📚 Riccardi et al. European Heart Journal Acute Cardiovascular Care, 2025 doi.org/10.1093/ehjacc…

💊 HIF-PHI in CKD Anemia (KDIGO 2026) 🔹 Not 1st line → ESA preferred 🔹 Use when: • ESA hyporesponse • ESA intolerance • Prefer oral therapy ⚙️ MOA: ↑ HIF → ↑ EPO ↓ Hepcidin → ↑ Iron availability → Better erythropoiesis 💊 Doses (quick recall): • Roxadustat: 70/100 mg TIW • Daprodustat: 4 mg OD • Vadadustat: 300 mg OD • Desidustat: 100 mg TIW 🎯 Target Hb: ~10–11.5 g/dL ⏱️ Adjust every 4 weeks ⚠️ Avoid: • Recent MI/stroke • Thrombosis • Active malignancy 🚫 Don’t combine with ESA 🔥 Take home: Oral alternative to ESA—best for ESA resistance with careful monitoring #GSR #BuddingNephros #Anemia #CKD

Recent review #Latent_Tuberculosis #CKD - Common & underdiagnosed • #IGRA preferred over #TST • Screening should be: – Targeted in pre-dialysis – Systematic at dialysis initiation – Mandatory before transplantation @AfricanAFRAN @ISNkidneycare @ERAkidney @goKDIGO @com_SFNDT