Freely Filtered, a NephJC Podcast

The Filtrate:Joel TopfSwapnil HiremathNayan AroraJennie LinJoshua WaitzmanSpecial GuestsAlfred Kim assistant Professor at Washington University, director of the lupus clinic. Receives support from Arena Pharmaceuticals, manufacturer of volcloosporin, or at least he did before this episode aired.Dawn Castor assistant professor at The University of Louisville School of Medicine. She is on the speaker bureau for Arena Pharmaceuticals, manufacturer of volcloosporin. She was a site principle investigator (PI) as well as an author of the trial.EditorNayan AroraShow Notes:NIH Cyclophosphamide trial, long term follow-up: Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Other important publications on this trial include:Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs NEJM 1986Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis Lancet 1992Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamideVoclosporin is approved by FDA in January 2021Previous Lupus Nephritis podcast with Dawn and Alfred: Freely Filtered 029: Belimumab for lupus nephritisRituximab în Lupus. The LUNAR Trial (Spoiler, it didn’t work): Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab studySystematic review of the literature on reproducibility of the interpretation of renal biopsy in lupus nephritisConclusion The interpretation of renal biopsy in lupus nephritis is poorly reproducible, causing serious doubts about its validity and its clinical application. As it can lead to serious diagnosis, treatment and prognosis errors, it is necessary to intensify research in this field.The ALMS trials of mycohenolate mofetil (MMF) trials in lupus nephritisInduction: Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis (JASN 2009)Maintenance: Mycophenolate versus Azathioprine as Maintenance Therapy for Lupus Nephritis (NEJM 2011)Jacob deGrom on the mound. Baseball Reference. DeGrom is a two time Cy Young award winner, a 4-time All-Star and former Rookie of the Year winner.AURORA2: Aurinia Renal Assessments 2: Aurinia Renal Response in Lupus With Voclosporin (ClinicalTrials.gov)Aurinia Pharmaceuticals.KDIGO 2021 Glomerulonephritis Guidelines Daily aspirin vs placebo for suspected acute myocardial infarction is highly protective except for patients born under Libra or Gemini. Current misconception 3: that subgroup-specific trial mortality results often provide a good basis for individualising patient careMultitarget therapy for induction treatment of lupus nephritis: a randomized trial.Patient Benefits Justify Price of New Lupus Nephritis Drugs“The estimated annual price of belimumab is approximately $43,000 per patient; the estimated annual price for voclosporin is approximately $92,000 per patient.”2019 update of the EULAR recommendations for the management of systemic lupus erythematosus GuidelineDr. Glaucomflecken on TwitterCardiology vs Nephrology Round 1Nephrology vs Cardiology Round 2In the Heights (Wikipedia)The Mitchells vs. the Machines (Wikipedia)Paws in PrisonFlozinator pin

The Filtrate:Joel TopfSwapnil HiremathNayan AroraSophie AmbrusoJoshua WeismanEditorJoel TopfShow Notes:Soccer star Christian Eriksen 'was gone' after on-field cardiac arrest, doctor says (NBC News)120-sided Die. This was covered in Wired Magazine. Respect. https://www.wired.com/2016/05/mathematical-challenge-of-designing-the-worlds-most-complex-120-sided-dice/ Nephrologists that played D&D: https://twitter.com/kidney_boy/status/1398660927680036865?s=20 Doctors that played D&D (i.e. control group): https://twitter.com/kidney_boy/status/1398661170328899586?s=20 Average sodium intake among Americans is 3,400 mg (147 mEq of Na per day). Sodium and the Dietary Guideline Factsheet (PDF)DASH Sodium Diet Trial https://www.nejm.org/doi/10.1056/NEJM200101043440101 The PURE Trial as discussed by NephJC and as seen in the NEJMFormulas to Estimate Dietary Sodium Intake From Spot Urine Alter Sodium-Mortality Relationship https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.13117 The Taiwan Nursing Home study: https://pubmed.ncbi.nlm.nih.gov/16762939/ Peruvian Cluster RCT of sodium reduction in Nature (oooh!) https://www.nature.com/articles/s41591-020-0754-2 DASH Diet in CKD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957723/ A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate https://pubmed.ncbi.nlm.nih.gov/23393104/ ACCORD https://www.nejm.org/doi/full/10.1056/nejmoa1001286 Kidney Damage Biomarkers and Incident CKD During Blood Pressure Reduction: A Case-Control Study within SPRINT https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953744/ Association of Urinary Biomarkers of Inflammation, Injury, and Fibrosis with Renal Function Decline: The ACCORD Trial https://pubmed.ncbi.nlm.nih.gov/27189318/ Lake Wobegon https://en.wikipedia.org/wiki/Lake_Wobegon SPRINT https://www.nejm.org/doi/full/10.1056/nejmoa1511939 Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia https://jamanetwork.com/journals/jama/fullarticle/2723256 Characterizing Frailty Status in the Systolic Blood Pressure Intervention Trial https://pubmed.ncbi.nlm.nih.gov/26755682/ Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the SPRINT Randomized Clinical Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045467/ The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening Concordance Between Blood Pressure in the Systolic Blood Pressure Intervention Trial and in Routine Clinical Practice https://pubmed.ncbi.nlm.nih.gov/33044494/

Jay L Koyner, a Professor of Medicine specializing in acute kidney injury (AKI) and dialysis, and Sarah Faubel, a Professor known for her contributions to medical education and renal health, join the discussion. They delve into the implications of the AKIKI-2 study on dialysis timing in AKI, emphasizing that late initiation may not worsen mortality outcomes. The conversation also touches on managing fluid volume in critically ill patients, innovative biomarkers for diagnosing AKI, and exciting developments in NAD therapy related to renal health.

The Filtrate:Matt SparksJennie LinSamira FaroukJoel TopfSwapnil HiremathAnd two special guests:Dawn J. Caster, Assistant Professor at University of LouisvilleAlfred Kim, Assistant Professor of Medicine at Washington University (Twitter)Show Notes:NephJC coverage of the trial: The Bliss trialIn the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2001180 Turtles all the way down: https://en.wikipedia.org/wiki/Turtles_all_the_way_down Nature previews Nephrology on BAFF: https://www.nature.com/articles/nri844 Phase III trial results with blisibimod, a selective inhibitor of B-cell activating factor, in subjects with systemic lupus erythematosus (SLE): results from a randomised, double-blind, placebo-controlled trial: https://pubmed.ncbi.nlm.nih.gov/29563108/ BRIGHT-SC: Blisibimod Response in IgA Nephropathy Following At-Home Treatment by Subcutaneous Administration: https://clinicaltrials.gov/ct2/show/NCT02062684 Guideline for naming monoclonal drugs: https://www.antibodysociety.org/wordpress/wp-content/uploads/2017/07/INN-2017-Reference-20.pdf A long-term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group: https://pubmed.ncbi.nlm.nih.gov/9541091/ Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis https://pubmed.ncbi.nlm.nih.gov/25757867/ A Day In The Life Of Dr. Anthony Fauci: https://www.huffpost.com/entry/anthony-fauci-fighting-covid-19_n_5fc7fed7c5b61bea2b14e3eeMC Arbatin MD FPCP FPSN @mcamd: the glomerulus tree: https://twitter.com/mcamd/status/1337744822543605760 finished product: https://twitter.com/mcamd/status/1338429211963322371