Swapnil Hiremath 🍁🇨🇦

@hswapnil.medsky.social

6052 Followers 3286 Following

Nephrologist = kidney doctor MD, MPH Professor, University of Ottawa/Ottawa Hospital 🇨🇦 He/Him/His #NephJC co-creator; @FreelyFiltered.bsky.social pod panelist; KICR EiC: opinions personal https://www.swapnilhiremath.com

Copy of the book!
Algorithm
Figure 1 Native kidney histopathology at autopsy in two cardiac xenotransplant recipients. (a, b) Light microscopy (hematoxylin and eosin). (a) Patient 1: proximal renal tubules with severe luminal dilatation and epithelial flattening and simplification; segments of denuded tubular basement membrane (arrow). Inset: preserved glomerulus. (b) Patient 2: proximal tubules with luminal dilatation, flattened epithelium, and cytoplasmic vacuolization. Inset: glomerulus with a subtle increase in mesangium (arrowheads). (c, d) Transmission electron microscopy. (c) Patient 1: glomerular capillaries with overall normal glomerular basement membrane and preserved podocyte foot processes without effacement. (d) Patient 2: glomerular capillaries with thickened glomerular basement membrane and increased mesangial matrix (M), consistent with early diabetic glomerulosclerosis; preserved podocyte foot processes without effacement (arrows), despite degenerative changes attributable to post-mortem autolysis. Scale bars: 50 Îźm (a, b; insets as marked); 6 Îźm (c); 4 Îźm (d).
Figure 2 Intervention items. Participants received tailored, multidomain care based on CGA. Nutrition: dietitian-led assessment, diet-record handbook, and an individualized plan with daily energy/protein targets; nutritional supplements (e.g., whey protein or enteral formula) when indicated. Psychology: GDS screening; if positive, psychiatrist/psychologist–guided pharmacotherapy and twice-weekly one-to-one psychotherapy (supportive, psychoeducation, and relaxation). Physical function: specialist-prescribed, home-based program (moderate, progressive; 3× per week; 30 to 45 min; 12 months) targeting strength, balance, and flexibility with warm-up and cool-down. Participants with multiple deficits received concurrent components.
Figure 1
VA
Figure 1 Thailand’s prevention-focused CKD strategy, shifting from dialysis-centered care to population-level prevention through multisectoral collaboration—emphasizing early screening, salt reduction, multidisciplinary care, and equitable access to essential medicines. Abbreviation: CKD, chronic kidney disease; FPs, family physicians; GPs, general physicians; NGO, non-governmental organization; VHVs, village healthcare volunteers.
“Yet, in Canada, every decision seems to be made in splendid isolation, with no attention paid to the big picture. To be eligible for treatment with lecanemab a patient must have a diagnosis of mild cognitive impairment or mild dementia owing to Alzheimer’s. (The wait time to see neurological specialists in Canada is up to a year.) Genetic testing is required because people with two copies of the gene variant APOE4 are not eligible. (It’s not a routine screening test.) The drug is infused every two weeks in a hospital setting. Patients also require regular MRI scans. (The wait time for MRIs can be months.) It is debatable whether the system could administer this drug effectively. The CDEC also says the drug should be funded for six months, and discontinued if the disease progresses to moderate dementia. But our system is terrible at saying “no.” The gift of care for people with Alzheimer’s disease Lecanemab costs about $30,000 a year. The CDEC calculated that, even with strict conditions, funding lecanemab would cost provincial drug plans $66-million in the first year, and $485-million by year three. Is that the best way to spend public dollars for dementia care? Or ” Excerpt From “Opinion: How do you judge the real value of a new Alzheimer’s drug?” André Picard The Globe and Mail https://apple.news/A9Ykirj_JRx-vxLSHW0zYdA This material may be protected by copyright.
After 3 days, Mei developed a fever, a common reaction to AAVs that was expected to last for a couple days. Qiu swung by as her fever began to wane. He assured Jason and Linda that their daughter’s condition would soon improve. As they walked him to the elevator, he announced—excitedly—that the Nature paper had been accepted with revisions. Then he added that Mei’s treatment would make an even bigger splash: the first brain-directed gene-editing therapy. Mei did not improve. Because she hadn’t urinated since the infusion—a sign that her kidneys had been seriously injured—her doctors had limited her fluid intake, and she became desperately thirsty. The platelets in her blood also dropped to dangerous levels. It was the exact sequence of symptoms that the consent form had warned the family about. But nowhere did the form explicitly indicate that any of this could end in death, nor did that come up during any conversations with Qiu or the other doctors, Jason and Linda say. “Death should always be mentioned in a first-in-human trial,” says Greely, the bioethicist. Doctors took Mei for a full-body CT scan and then rushed her to the intensive care unit. Her brave face had begun to crack. “Mom, I want to go home,” she told her mother, before vanishing into the ward. Over the next 24 hours, Jason and Linda sat in the waiting room with their elderly parents. Qiu, who had returned upon hearing of Mei’s problems, seemed unable to process it. He was still with the family the next morning when a doctor emerged to tell them Mei had died. Qiu was in shock, Jason recalled. So was the family. They stood by Mei’s body and caressed her one last time. TWO DAYS LATER, the hospital’s ethics board convened an emergency meeting and concluded Mei’s death was “definitely related” to the treatment, according to its report. The cause of death: thrombotic microangiopathy.
Altmetric of ADA editorial
Data current through March 2026. Number of defaulted borrowers calculated by combining borrowers delinquent by 271-360 days and borrowers delinquent by over 360 days. Payment pause includes the pause implemented by the CARES act as well as the yearlong on-ramp period that moved loans to forbearance status after 90 days of missed payments. Source: The office of Federal Student Aid Red line was going down with pause on payments - and is going straight up in last 18 months
Space X stock price
lab values showing hypokalemia elevated ESR/CRP
At a less acute level, Alice was struggling with the question of how much of the scut work she should do and how much to delegate to the intern. When was doing the scut work giving her intern time to think and learn? And when was it interfering with the intern’s learning by depriving them of their experience? In other words, when is sitting back and letting someone else do the tedious work of hospital care “growth,” and when is it “exploitation”? Even more poignantly, Alice was asking how much she should let her trainees do things differently than she would. The interns are, after all, doctors. Surely they can organize their notes in their own way.
Tables
Figure 2:Example of mass spectrometry analysis of the main compound in one of the traditional medicine products: (A) GC–MS chromatogram, with time on the x-axis and signal intensity on the y-axis. The peak centered at 23.40 min indicates that a compound elutes from the GC column at 23.40 min. (B) Top: Spectrum of the compound eluting at 23.40 min, with each vertical bar representing an ion fragment; bottom: comparison with the reference spectrum of the molecule proposed by the library (mefenamic acid). (C) LC–HRMS chromatogram. The peak centered at 13.413 min indicates that a compound elutes from the LC column at 13.413 min. (D) Top: The HRMS MS1 spectrum of the compound eluting at RT 13.413 min, providing the exact neutral molecular mass [M + H]+ of the compound; bottom: the HRMS MS2 spectrum of the compound eluting at RT 13.413 min, enabling structural identification and comparison with a collection of reference MS2 spectra associated with identified molecules (here mefenamic acid). (E) Composition of all compound identified in high-resolution mass spectrometry. GC–MS: gas chromatography–mass spectrometry; LC–HRMS: liquid chromatography–high-resolution mass spectrometry; RT: retention time.
Figure 2 Change from baseline to week 136 in eGFR in the atrasentan and placebo group in the main stratum (A), SGLT2 inhibitor stratum (B), and pooled strata (C)
Katherine Long: No. No. Most people lose money on Polymarket. Ryan Knutson: Who does win money on Polymarket? Katherine Long: Almost nobody. Previously we reported that 70% of Polymarket users lose money. That's based on Caitlin's incredible data analysis. Ryan Knutson: Caitlin found that about two-thirds of the profits on Polymarket go to 0.1% of users. And those users tend to be small hedge funds and trading firms that are informed by reams of data. Meanwhile, the average better who's losing money looks a lot like the people in those fake videos. Caitlin Ostroff: The primary audience for people to gamble, whether it's sports betting or prediction markets, is young men.
Can’t hide the disgust See the second from left - others have a reasonable poker face to hide their feelings
The nephrology boot camp Toasting to some flavored urea 🥂
Figure 2. Back-table preparation of the vascularised composite bladder allograft, creating a single arterial inflow and a single venous outflow supplying the entire bladder
Table. Foods With Higher and Lower Potassium Levels by Region and Ethnicitya
Nopales or prickly pear cactus
Graph showing difference between midterm (LLM aided) versus final (unaided) scores
bootcamp
Journal logo
The course, which he has been teaching for years, is not an easy one: it typically attracts few students, but very good ones. He has never had more than 30 students enrolled at a time, and on some occasions he had only eight. This semester, probably because of the new evaluation system, 86 students signed up for the class. The results of the midterm exam, which was administered on March 5, were extraordinary, with an average score of 96 out of 100. Forty students scored a perfect 100. The people who corrected the exams warned him about several irregularities. “Some answers contained unusual passages that coincided with results obtained after running the questions through ChatGPT,” he says. Serrano did not void the midterm exam, but warned students that the final one, which counted for 50% of the final grade, would be held in-person. He also said that if the grade distribution was not similar to the midterm, only the final exam would be taken into account. The average score dropped to 48 out of 100. Of the 89 students who did the midterm exam, only 59 showed up for the final one. And of the 27 who did not show up, 22 had scored a perfect 100 in the midterm exam.
In a few words
Table 2. Primary and secondary outcomes (adjusted analysis)
Dr Douvris on Grand Rounds tomorrow
Potassium salt as one of the ingredients in Cheetos - snapshot from Science Snitch reel where she breaks down all the ugh-ly ingredients in processed food
page views (47,407) and PDF downloads (4482) of the editorial - all in last 2 days
Metrics of the diabetes care editorial BlueSky posts ~ 9x the twitter posts Page views now ~ 7000 - mostly in last 24 hours since ADA called the police in the authors
Because it was not done for registration. It was an investigator initiated study. Reason provided for why MENTOR didn’t lead to Rituximab approval
A 56-year-old woman presented to the emergency department with a 3-week history of leg swelling. On physical examination, pitting edema in both legs and a milky appearance to the urine were observed (Panel A). Laboratory studies were notable for a serum albumin level of 18 g per liter (reference range, 35 to 52) and a urinary protein-to-creatinine ratio of 34,958 (with protein measured in milligrams and creatinine measured in grams; reference range, 0 to 200). Further testing of the urine identified elevated levels of chylomicrons and a urinary triglyceride level of 1456 mg per deciliter (reference value, undetectable), findings indicative of chyluria. Chyluria results from abnormal communication between the lymphatic and urinary systems. Possible causes are lymphatic filariasis, congenital lymphatic malformations, post-traumatic lymphatic malformations, and lymphatic compression by tumors. Lymphangiography (after the placement of a right-sided ureteral stent) identified retroperitoneal lymphatic malformations (Panel B, white arrows) with a fistulous communication to the right pyeloureteral junction (Panel B, black arrow). Whether the lymphatic malformations were congenital or acquired was unclear. A diagnosis of chyluria from a lymphatic–urinary fistula was made. The chyluria persisted despite the patient’s following a low-fat diet, so the fistula was subsequently closed by percutaneous transabdominal embolization. At follow-up 3 months later, the appearance of the urine had normalized (Panel C; apparent layering is due to a label on the back of the tube), the patient’s serum albumin levels had improved, and the edema and proteinuria were markedly reduced.
splash slide
First Adjudicated Flare of IgG4-Related Disease for Which Rescue Therapy Was Required (Intention-to-Treat Population).
Visual abstract
Figure 2. Alluvial Plot Showing Differences in Phenotype Assignment Based on Phenotypes Derived From Individual Sites Including From SENECA (Sepsis Endotyping in Emergency Care)
Figure 1 Breast arterial calcification. First, third, and fifth mammogram from one subject who started on the acetate arm and finished on the citrate arm.
Figure 2. Heat Map of Surface Under the Cumulative Ranking Curve (SUCRA) for Treatment Discontinuation Due to Adverse Events and Specific Adverse Events
CFS vs treatment choice after Geriatrician review.
Visual abstract
Number of global clinical trial starts by region (2013, 2018–23; phase 1–4). Source: IQVIA-EFPIA-Vaccines Europe, ‘Assessing the clinical trial ecosystem in Europe—Final report, October 2024’, available from: https://efpia.eu/media/3edpooqp/assessing-the-clinical-trial-ecosystem-in-europe.pdf.
filtrates
formal announcement WCN 2027 changed from Dubai to Kuala Lumpur
LBCT 1
The advancements in the field of nephrology in terms of diagnostics, biomarker selection, and therapeutics. Abbreviations: US, ultrasound; ns-MRA, non-steroidal mineralocorticoid receptor antagonist; TIMP-2, urinary tissue inhibitor of metalloproteinases-2; IGFBP-7, insulin-like growth factor-binding protein-7; MCP-1, monocyte chemoattractant protein-1.
splash slide
PDF scan
5 things about AVP DI PDF capture
Objectivity and the Prior A prior or prestudy assumption about the distribution of treatment effects must be defined when bayesian analyses are implemented. Objectivity in constructing the prior is crucial for distinguishing scientific from wishful thinking and avoiding conflation of evidence-based belief with desired effects. Many RCTs have overturned expert opinion and conclusions derived from observational data, underscoring the need for caution when selecting a prior distribution. Scientific objectivity and avoidance of bias may be maximized by using uninformative priors, often yielding results equivalent to frequentist analyses.5
“Kissei told doctors Friday to stop prescribing the drug to new patients. The Japanese drugmaker said the 20 deaths occurred in people who had suffered a serious liver “impairment” and attributed 13 of the deaths to a condition, called vanishing bile duct syndrome, marked by the destruction of the ducts that carry bile out of the liver. Kissei said causal links to Tavneos hadn’t been confirmed in all 20 deaths. Amgen shares were down more than 2% late Friday. An Amgen spokeswoman said the 20 deaths occurred among more than 8,500 patients treated in Japan, and that some cases involved deaths where a causal link to Tavneos hadn’t been established. She added that no deaths linked to serious liver injury have been reported among the more than 8,000 U.S. patients who have taken the drug. CSL, which holds the rights to sell the drug outside the U.S. and licensed it to Kissei for sale in Japan, said it “takes all matters of patient safety seriously” and is committed to working with regulators. “Kissei has begun providing information to healthcare professionals, urging them to refrain from using this drug for new patients and to carefully assess the continuation of treatment for ” Excerpt From “20 People in Japan Died After Taking Amgen Drug” Xavier Martinez The Wall Street Journal https://apple.news/A8Woi0mr1QImP29g7fxzZfQ This material may be protected by copyright.