Sebastian Jilch MD

Hospitalist, internal medicine with a love for nephrology || views are my own || #FOAMed

[Shreshta Tripathi @ShreshtaT]

🧬 The ROADMAP era in MN is here.

MENTOR, RI-CYCLO, STARMEN & GEMRITUX trials reshaping membranous nephropathy management ⚡

B-cell targeted therapy vs traditional regimens

@isn_india @ISGDtweets @raja_1980 @drshyambansal

[Abdelhamed Hamdy @Abdelhamed6261]

IgA treatment need precision medicine

[Abdelhamed Hamdy @Abdelhamed6261]

Urinary rituximab loss and rate of treatment failure in membranous nephropathy

[Srinivas Mahesh Prasad Nephrologist @NephPrasad]

ATG for Treatment of TCMR

#Nephrology #Transplant #Nephtwitter #Medicine #MedTwitter

[CKJ @CKJsocial]

Executive summary of the European consensus report on the diagnosis and treatment of monoclonal gammopathy of renal significance

https://t.co/kXkfPZwg0J

[Abdelhamed Hamdy @Abdelhamed6261]

Phosphate binders

[Srinivas Mahesh Prasad Nephrologist @NephPrasad]

TACROLIMUS

PROGRAF v/s ADVAGRAF v/s ENVARSUS XR

#Nephrology #NephTwitter #Nephro #Medtwitter #Transplant

[Srinivas Mahesh Prasad Nephrologist @NephPrasad]

Role of IVIG in BK Virus Infection

#BKV #Nephro #Nephtwitter #Medtwitter #Medicine #Transplant

[Srinivas Mahesh Prasad Nephrologist @NephPrasad]

Tacrolimus: Route of Administration
#Nephrology #Nephro #Medicine #MedTwitter #Nephtwitter

[Sayed S Rahman @SayedSRahman1]

BANFF CLASSIFICATION OF RENAL ALLOGRAFT BIOPSY 2022 :
6 CATEGORIES
#BANFF
https://t.co/tOUzoLIREK

[Edgar V. Lerma 🇵🇭 @edgarvlermamd]

That's a NO ❌ to Beta Blockers in #Hepatorenal syndrome
#Nephpearls

👉 https://t.co/BsMT1ihAHT

[VR.Krishnakumar @KKNephBytes]

Post transplant diarrhoea #transplant #diarrhea
@arvindcanchi @CMEINDIA1 @DrAkshayaJ @DrMedhavi_G @drshyambansal @hafeeq_benil @hardik4u24 @IamGopambuj @isn_india @myadla @priti899 @suhalikapath @

[Gopambuj Singh Rathod @IamGopambuj]

Membranous nephropathy is no longer just “primary vs secondary” disease — it is now an ANTIGEN-SPECIFIC podocytopathy.

🔬 Newer antigens are redefining diagnosis & prognosis:
▪️ NELL1 → malignancy/drug-associated MN
▪️ EXT1/EXT2 & NCAM1 → lupus/autoimmune MN
▪️ SEMA3B → pediatric MN
▪️ FAT1 → post-HSCT MN
▪️ CNTN1 → neuropathy-associated MN
▪️ PCDH7 → indolent MN phenotype

⚡ Emerging concept: Dual-antigen MN
(NELL1+PLA2R, NCAM1+EXT1/2 etc.) suggesting complex autoimmune evolution.

🧪 Mass spectrometry-based antigen mapping is becoming the future gold standard for PLA2R-negative MN.
#GSR #BuddingNephros #MembranousNephropathy #RenalPathology #NephTwitter #MedTwitter

[Tiffany Caza @Tiff_Caza]

New recommendations for IgAN therapy incorporating BAFF/APRIL blockade and complement inhibitors.
By @AKronbichler at @GlomCon

[Abdelhamed Hamdy @Abdelhamed6261]

Dialysis patients vaccinations

[Mohamed Hassanein 🇪🇬 محمد حسنين @kidneymo]

Presentation of Complement Mediated Glomerular Disease is affected by:
🔴 Site of dysregulation
🔴 Type of dysregulation
🔴 Mediator of Disease

From Dr. Abdallah Geara's fantastic talk on Complement Dysregulation in Glomerular Diseases @glomconarabia

Join now:
Meeting ID: 884 4208 1901
Passcode: 100499

[Dr. Divya Bajpai 🇮🇳 @divyaa24]

As nephrologist Iam always interested in looking what it does to kidney tissue?

Findings of TMA -
🔬
Great session by Dr Sharon Ford at @GlomCon

[Gopambuj Singh Rathod @IamGopambuj]

🚰 Hemodialysis is no longer just about diffusion.
💡 The future is convective.

#Hemodiafiltration (#HDF) combines diffusion + convection to achieve superior clearance of middle molecules and protein-bound toxins.

📚 Trials like
• ESHOL Trial
• CONTRAST Trial
• CONVINCE Trial
suggest better survival and cardiovascular outcomes with high-volume HDF.

🎯 Target convection volume:
➡️ ≥ 23 L/session

Why nephrologists are increasingly embracing HDF:

✅ Better middle molecule clearance
✅ Improved hemodynamic tolerance
✅ Better phosphate control
✅ Reduced inflammation
✅ Potential survival benefit

“More than filtration.
It’s better purification.
It’s better care.”
#GSR #BuddingNephros
#Nephrology #Dialysis #KidneyDisease #CKD #NephTwitter #MedTwitter #HDF

[Gopambuj Singh Rathod @IamGopambuj]

🧠 Mycophenolate (MMF/MPS) in Renal Transplant

🔬 MOA: Inhibits IMPDH → ↓ T & B cell proliferation → ↓ rejection

💊 Dose:
MMF: 1–1.5 g BD
MPS: 720 mg BD (≈ MMF 1 g BD)

⚠️ When to reduce:
• Leukopenia / Neutropenia
• Severe diarrhea
• CMV / BK / sepsis
• Malignancy

🚫 No renal dose adjustment

📉 First drug to reduce in infection = Mycophenolate
#GSR #BuddingNephros #Transplant #Mycophenolate #NephX

[Gopambuj Singh Rathod @IamGopambuj]

🧪ART in CKD

🔹 Golden rule: Adjust NRTIs (except ABC); others usually no change

🔹 Avoid/limit Tenofovir

TDF ❌ if eGFR <30 (nephrotoxic)

TAF ✅ safer (use if eGFR ≥15)

🔹 Preferred regimens

CKD: ABC + 3TC (dose adjust) + DTG

Or TAF-based + INSTI (if eGFR ≥15)

🔹 No dose adjustment

NNRTIs, Protease inhibitors, Integrase inhibitors

🔹 Hemodialysis

Give ART after HD

Adjust only NRTIs

👉 Bottom line:
Avoid TDF in advanced CKD, use ABC/TAF-based regimens, and pair with INSTI (DTG/BIC).
#GSR #BuddingNephros
#Nephrology #HIV #CKD #ART #Dialysis