Dr. Raúl Zenteno Langle

Médico Especialista en Nefrología y Medicina Interna. Mi razón de ser y total compromiso es con mis pacientes, siempre con una base sólida en conocimientos.

[INTERNAL MEDICINE @medicinterna]

ACP Mexico Chapter. Doctor's Dilemma 2026 winners, INCMNSZ. CONGRATULATIONS.

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🩻Contrast-induced AKI:
one of the biggest myths still shaping clinical decisions

For decades we were taught:

👉 “Contrast damages the kidneys”
👉 “Avoid CT with contrast in CKD”
👉 “Hydrate, protect, delay imaging if needed”

But what if… most of this is wrong?🤔

->The uncomfortable reality

Modern evidence shows:

👉 Low-osmolar contrast rarely causes true nephrotoxicity
👉 Even in CKD, AKI, and ICU patients
👉 The risk is often overestimated—or nonexistent

So where did the fear come from?

📍 1950s high-osmolar contrast (actually toxic)
📍 Poorly controlled observational studies
📍 “Creatinine rise = contrast injury” assumption

👉 Correlation became causation
👉 And the dogma stayed

⚠️What recent data tells us

✔ No difference in AKI rates with vs without contrast
✔ No benefit from bicarbonate, NAC, or aggressive hydration
✔ Even ICU and AKI patients show no worsening outcomes

->Translation to real life

👉 The patient was going to develop AKI anyway...Not because of contrast!!

->The real problem: “Renalism”

👉 Avoiding necessary imaging
👉 Delaying diagnosis
👉 Choosing inferior tests

And that leads to:

❌ Missed PE
❌ Delayed sepsis source control
❌ Worse outcomes

->Clinical mindset shift

Instead of asking:

👉 “Will contrast harm the kidneys?”

We should ask:

👉 “Will NOT doing the scan harm the patient?”

->Who still deserves caution?

✔ eGFR <30
✔ Severe hemodynamic instability
✔ Multiple nephrotoxins

Even then:

👉 Optimize volume
👉 Minimize dose
👉 Don’t delay critical imaging

🤓Bottom line

✔ Contrast nephrotoxicity exists… but is rare
✔ The fear is bigger than the risk
✔ The harm of NOT imaging is often greater

In critical care

👉 We don’t treat creatinine
👉 We treat patients

And sometimes…

👉 The most dangerous thing is NOT the contrast

👉 It’s hesitation.

📃Reference
Florens N, Demiselle J.
Kidney360 7: 445–449, 2026. doi: https://t.co/CWzi7WC9Wx

[Christian Caroli @DrCCaroli]

🔥 Una nueva actualización sobre el tratamiento hipolipemiante. Guidelines 2026 #ACC/#AHA, mucho para leer y discutir.

💡Destacó 10 ideas y alguno de los principales algoritmos del documento para @clinicasac.

[Dr. Chokri Ben Lamine @abouabdrahman0]

🧬 50 Pearls on GLP-1 Receptor Agonists & Next-Gen Incretins

(Based on The Lancet Review, Nauck et al., 2026 )

1️⃣ GLP-1 RAs revolutionized T2DM therapy 🎯
2️⃣ Strong HbA1c reduction with low hypoglycemia risk ⚡
3️⃣ Weight loss is a class effect 📉
4️⃣ CVOTs confirm CV safety ❤️
5️⃣ Several agents reduce MACE significantly 🫀⬇️
6️⃣ Liraglutide, semaglutide, dulaglutide → proven CV benefit 🏆
7️⃣ Tirzepatide non-inferior vs dulaglutide for MACE 🔄
8️⃣ Stroke risk reduction consistent across trials 🧠⬇️
9️⃣ MI risk modestly reduced 💥⬇️
🔟 All-cause mortality reduced in meta-analysis 📊⬇️

1️⃣1️⃣ SELECT trial: semaglutide reduced MACE in obesity without T2DM 🎉
1️⃣2️⃣ CV benefit independent of glucose lowering 🔬
1️⃣3️⃣ GLP-1 RAs improve BP & lipids 🩺
1️⃣4️⃣ Anti-inflammatory vascular effects described 🔥⬇️
1️⃣5️⃣ Albuminuria reduction consistent 🧪⬇️
1️⃣6️⃣ Slows eGFR decline 📉
1️⃣7️⃣ FLOW trial: semaglutide ↓ kidney failure risk 🧂
1️⃣8️⃣ Kidney benefits partially independent of HbA1c 🧠
1️⃣9️⃣ Direct renal GLP-1 receptor expression documented 🧬
2️⃣0️⃣ Immune modulation may mediate renal protection 🛡️

2️⃣1️⃣ Higher doses needed for obesity vs T2DM ⚖️
2️⃣2️⃣ Semaglutide 2.4 mg > liraglutide 3 mg for weight loss 💪
2️⃣3️⃣ Tirzepatide > semaglutide for weight reduction 🔥
2️⃣4️⃣ Weight regain common after discontinuation ↩️
2️⃣5️⃣ HFpEF improves symptomatically with GLP-1 therapy ❤️‍🩹
2️⃣6️⃣ Reduced HF hospitalization risk 🏥⬇️
2️⃣7️⃣ MASLD regression documented 🍔➡️🫀
2️⃣8️⃣ Fibrosis progression reduced in MASLD trials 🧵
2️⃣9️⃣ Tirzepatide approved for OSA 😴
3️⃣0️⃣ OA knee symptoms improved with weight loss 🦵

3️⃣1️⃣ Progression from prediabetes ↓ up to 93% 🚫🍬
3️⃣2️⃣ Dual GIP–GLP-1 agonism enhances efficacy 🧪
3️⃣3️⃣ Triple agonists under development 🚀
3️⃣4️⃣ Glucagon–GLP-1 agonists ↑ energy expenditure 🔥
3️⃣5️⃣ Amylin–GLP-1 combos show major weight effects ⚖️⬇️
3️⃣6️⃣ Retatrutide → 20%+ weight loss 🔥🔥
3️⃣7️⃣ Small-molecule oral GLP-1 (orforglipron) emerging 💊
3️⃣8️⃣ GI adverse events remain class-limiting 🤢
3️⃣9️⃣ Slow titration improves tolerability 🐢
4️⃣0️⃣ Lean mass reduction noted — clinical impact uncertain 🏋️

4️⃣1️⃣ Rare optic neuropathy signal reported 👁️
4️⃣2️⃣ No consistent dementia prevention proven 🧠❓
4️⃣3️⃣ Parkinson’s disease data mixed 🔄
4️⃣4️⃣ Substance use disorder research ongoing 🍷🚬
4️⃣5️⃣ Real-world data confirm CV protection 🌍
4️⃣6️⃣ Hypoglycemia mainly with SU co-use ⚠️
4️⃣7️⃣ No intrinsic nephrotoxicity signal 🚫🧂
4️⃣8️⃣ Adherence influenced by GI tolerability 📉
4️⃣9️⃣ Dose escalation strategy crucial 🎯
5️⃣0️⃣ Incretin era reshaping cardiometabolic medicine entirely 🌍🔥
#lancet

[Paola Morejón Barragán @paomorejon]

📌Estudio FRESH-UP
Ingesta de líquidos en #InsuficienciaCardiaca: liberal 🆚 restricción

🤭Los mitos se caen
Restringir los líquidos (<1500 ml) no tiene beneficio, disminuye el bienestar a los pacientes

👥504 NYHA II-III
⏱️ Seguimiento por 3 meses

❌No recomendar restricción de líquidos para prevenir la congestión.
🚨La restricción puede incrementar la sensación de sed, hospitalizaciones, AKI

🔔 En #IC avanzada, es lo mismo?
Tampoco restringimos, individualizamos pero se necesitan estudios en esta población

https://t.co/znDzLYPp3V

#HeartFailure #CardioEd #CardioTip #MedTwitter #Medicina #Cardiology #Cardiologia

[Roberto Alcazar @ralcazara]

¿Todavía ajustas el Ca a las proteínas?. En @JAMA_current - https://t.co/1CeAE1HlOu - vuelve a demostrarse que: Es mejor el Ca no ajustado. El ajustado sobreestima las hiperCa e infraestima las hipoCa. Para ajustes finos o dudas: Ca iónico - @SOMANEorg @SENefrologia #Nefro_8_01

[Jonathan Chávez @JonathanNefro]

Nuestro nuevo Artículo Original está en línea y gratis

El primer metaanálisis de lesión renal aguda en México, reportamos su alta incidencia (35%) y mortalidad (36%), entre otras cosas

Junto con @zaragozagalvan y Armando Vázquez

Renal Failure 2025
https://t.co/PSN5bNpzYU

[Jasmine Sethi @JasmineNephro]

✅Prophylactic anticoagulation in nephrotic syndrome

🅰️Hypoalbuminemia (&lt;2) with one of following

🎯Proteinuria &gt;10gm/day
🎯BMI&gt; 35
🎯Heart 💔 failure
🎯Genetic predisposed for thrombosis
🎯/Recent abdominal surgery

@goKDIGO @ISNkidneycare

[Jonathan Chávez @JonathanNefro]

Con gota y enfermedad renal crónica G3, utilizar alopurinol para alcanzar meta de ácido úrico (&lt;6 mg/dL), comparado a no hacerlo, no solo mantiene función renal, también ↓11% el riesgo de diálisis

Emulación de ensayo clínico

JAMA Intern Med 2024
10.1001/jamainternmed.2024.6212

[Ramiro Esparza @docramiro]

Nuevo criterio diagnóstico de prediabetes y diabetes:
Carga de 75 gramos oral con glucosa en suero a la hora.
≥ 155 mg/dL = Prediabetes
≥ 209 mg/dL = Diabetes
Referencia: https://t.co/4B6NlKoexu

[Jasmine Sethi @JasmineNephro]

🎯Antiphospholipid Syndrome

[Jasmine Sethi @JasmineNephro]

🎯🫘Hemodialysis in Poisonings

@AJKDonline

[Fulham Football Club @FulhamFC]

Raúl has won our September Goal of the Month. 🔥

Watch all angles and you can see why. 😍

[Jasmine Sethi @JasmineNephro]

🧪Liver Function tests

[Dr. AK 🇮🇳 @docakx]

🌟 SGLT2i in CKD - Guidelines

[Top Biomedical Science @imedverse]

HYPERTENSION Guideline 2024

Via @DrAkhilX #MedEd #MedX #hypertension

[Doctoranefro @DraJcadenanefro]

Al mandar el estudio metabólico de 24 horas para litiasis renal es importante recordar: (tabla de ayuda)

[Gabriel Puche, MD/PhD @gabi_puchepalao]

🧠¿Cuando puedo iniciar ACOD después de sufrir un 💥ictus isquémico?

➡️Regla de 1-3-6-12 🗓️días

🌏base datos combinada de 2 registros 🇯🇵japoneses, se determinó el momento óptimo para iniciar ACOD

💊 ACOD tienen principal ventaja de menor riesgo hemorragia intracraneal

[Journal of Brown Hospital Medicine @BrownJHM]

Approach to hyponatremia @PathwayMedical #FOAMed

[Int Society of Nephrology @ISNkidneycare]

📖 This weekend don't miss our @KIReports #ISNFridaySelection: Key points in managing PLA2R-associated membranous nephropathy https://t.co/M9kn2cJf5I