Pablo Angeles Tacchino

🧠 HRS-AKI: How Terlipressin, Midodrine & Octreotide Work HRS is driven by severe splanchnic vasodilation → ↓ effective arterial volume → renal vasoconstriction → ↓ GFR. 💊 Terlipressin → V1 agonist → splanchnic vasoconstriction → ↑ effective circulation → ↑ renal perfusion (FIRST LINE) 💊 Midodrine → α1 agonist → ↑ MAP → improves renal blood flow 💊 Octreotide → ↓ vasodilators (like glucagon) → ↓ splanchnic vasodilation 🔥 Combo (Midodrine + Octreotide): Synergistic → ↑ MAP + ↓ splanchnic pooling #GSR #BuddingNephros #kidney #Liver

Creo que ahora que finerenona quiere usar si o si en todo el espectro cardiorenometabolico pero en ICC preservada siempre se encuentra con estudio TOPCAT de espironolactona que fue negativo pero mal diseñado, y que podía ser positivo solo para la Americas, luego aparece esto .

Phosphate - latest news and ongoing trials @CKJsocial t.me/internalmedici… academic.oup.com/ckj/advance-ar…

So #NephTwitter, how often are you checking a cholesterol panel? What’s your goal for LDL? 100, 70, 55 or lower?! Intensive control had less creatinine elevation, look at that p-value! (NEJM 4/9/26) nejm.org/doi/full/10.10…

Optimal glucocorticoid therapy in lupus nephritis doi.org/10.1093/ndt/gf…

Los hijos nacidos cuando sus madres se hemodializan, tuvieron: •43% prematurez •44% distrés respiratorio •24% malformaciones •4.7% muere a la semana Cohorte representativa nacional francesa NDT 2026 academic.oup.com/ndt/advance-ar…

I Couldn't agree more.I thought POCUS would win easy

Antiproteinuric effect of SGLT2 inhibitors in non-diabetic glomerulopathies is dependent on body mass index doi.org/10.1093/ndt/gf…

Mayo MGRS Prediction Tool calculator mdevans.shinyapps.io/mgrs_app/

The effect of GLP-1 receptor agonists on renal outcomes: a systematic review and meta-analysis doi.org/10.1093/ndt/gf…

Single-center perspective of glomerular pathology in checkpoint inhibitor-treated patients @Arjun_Mohan1 @MPAlexanderMD @HerrmannMd @KIReports kireports.org/article/S2468-…

¿Repetir biopsia renal en vasculitis ANCA? 🤔 Los datos clínicos y de laboratorio pueden sobreestimar la recaída. 👉 La biopsia sigue siendo clave para confirmarla. #google_vignette" target="_blank" rel="nofollow noopener">academic.oup.com/ckj/advance-ar… @SENefrologia @SOMANEorg

🧂Hiponatremia el resumen visual. 🧂Gracias @dra_miliflores #NephJ #NephTwitter nephjc.com/news/2026/4/4/…

10 tips del manejo posterior a lesión renal aguda 1-transición del seguimiento 2-citarlo en corto 3-mide albuminuria 4-mide Cistatina C en sarcopenia 5-reinicia iSRAA 6-indica iSGLT2 7-evalúa riesgo cardiovascular 8-considera lo psicosocial 9-educa al sujeto 10-manejo multidisciplinario CKJ 2026 academic.oup.com/ckj/advance-ar…

Perlas en diálisis !!! Proteinuria en el debut de Diálisis — Un predictor fatal 🚨📉 ¿Ignoramos la proteinuria una vez iniciada la HD? Error. Un estudio en NDT (2026) revela que la proteinuria nefrótica (>3.5 g/24h) al inicio de la técnica duplica el riesgo de pérdida acelerada de la función renal residual (FRR) y progresión a anuria. Preservar la FRR es hoy un imperativo para la supervivencia y calidad de vida. 📚 Ref: Sánchez Alamo B, et al. The deleterious effect of proteinuria in RKF in HD patients. Nephrology Dialysis Transplantation, 2026. #dialisis #nefrologia #riñon #medicina #nefrologia

Sex differences in cardiovascular–kidney–metabolic syndrome: the FINE-HEART pooled analysis. Read more in the @EHJ at doi.org/10.1093/eurhea… #CardioKidneyMetabolic #FineHeartStudy #SexDifferences #MetabolicSyndrome @ESCardio @ESC_Journals

A few thoughts on the late-breaking SPIRIT-HF presentation at #ACC26. This was unfortunately not a clean trial of spironolactone in HFmrEF/HFpEF. It was a trial with important methodological limitations that substantially weaken how confidently we can interpret the result. SPIRIT-HF was designed as a prospective, multicenter, randomized, double-blind, placebo-controlled trial of spironolactone in patients with HFmrEF/HFpEF at elevated cardiovascular risk. The primary endpoint was CV death plus total first and recurrent HF hospitalizations. On the surface, the primary result was neutral. But the larger story is that the trial did not adequately test its original hypothesis. The study enrolled only about half of the planned sample size and captured fewer events than expected, leaving it underpowered. Just as importantly, there was frequent and early study-drug withdrawal, with a substantial proportion of follow-up occurring after patients were no longer on assigned therapy. In that setting, an intention-to-treat analysis becomes much harder to interpret as a true biologic test of spironolactone. There are several additional reasons for caution. Background therapy also appears to reflect an earlier treatment era, with limited use of newer foundational therapies, making generalizability to contemporary practice less certain. What the study does show is that spironolactone had expected biologic effects, including changes in eGFR, potassium, and blood pressure. What it does not show cleanly is that MRAs definitively do not work in this population. The neutral primary result, and even the unfavorable late separation in some hospitalization analyses, must be interpreted in the context of under-enrollment, lower-than-expected event accrual, and substantial off-drug follow-up. My take: SPIRIT-HF is best viewed as an underpowered and methodologically challenged trial that does not provide a definitive answer. It raises important questions about role for steroidal MRA in this population. #ACC26

#SPIRIT-HF #ACC26 🧑‍⚕️ HF with preserved or mildly reduced EF (HFpEF/HFmrEF)—a large, underserved group with limited therapies 🧠 Does Spironolactone reduce CV death and HF hospitalizations, building on signals from prior trials like TOPCAT 📊 Trial was underpowered (COVID impact, lower enrollment, high drug discontinuation) → unable to definitively test hypothesis ⚠️ No clear primary outcome benefit; side effects and drug withdrawal were common, potentially blunting efficacy 💡 Takeaway: Signal for benefit may still exist—but tolerability + adherence remain the real barriers in HFpEF therapy Great Discussion by @dranulala 👏👏

Fisiopatologia Hematuria en IgA 🤓 ✔️Se ha tomado únicamente hallazgos en histología, proteinuria y eTFG como importantes factores pronósticos ✔️Se ha dejado d lado la hematuria que refleja el grado de Inflamación, ahi su importancia en IgA Floege et al. CKJ. 2026 #MedEd #NephX

First case of use of infliximab in regular AIN with minimal steroid. Borrowing from @onconephsociety world. kicasereports.org/article/S3117-… @ISNeducation Infliximab for Drug induced Acute Interstitial Nephritis