Adrian Covic

Professor Internal Medicine and Nephrology, MD, PhD, FRCP (London), FERA Try tweets for the fun of science, go to Journals for the fun science

[AHA Science @AHAScience]

Published today, the first-ever clinical practice guideline on cardiovascular-kidney-metabolic (CKM) syndrome from the American Heart Association and @ACCinTouch.

The focus of this clinical practice guideline is to create a living, working document that provides current knowledge in the field of CKM syndrome aimed at all practicing cardiologists, endocrinologists, nephrologists, and primary care and specialty clinicians who manage these patients.

✍🏼 @ChiadiNdumele @HeartDocSadiya @kardiologykazi @noshreza @virani_md @biykemb @NutritionHF @mandeepbajaj65 @KatherineTuttl8 @RangaswJ @lisaVWMD @KBreathettMD @EmoryFamMed @ShoaClarke @mad_sters @jmortonmd @sripalbangalore @AnumSaeedMD

[Adrian Covic @accovic]

A new paper from our group

[NEJM @NEJM]

Original Article: Obexelimab for the Treatment of IgG4-Related Disease (phase 3 INDIGO trial results) https://t.co/UP3IT4HLMN

Editorial: Obexelimab and the Promise of Nondepleting B-Cell Therapy in IgG4-Related Disease https://t.co/Km4LndkI5z

#EULAR2026 | @eular_org

[Brendon Neuen @brendonneuen]

Join us tomorrow at @ERAkidney for the launch of the CLARITY-IgAN Consortium in the high impact clinical trials in nephrology session (starting at 8:15 BST)

A collaborative meta-analysis of the efficacy and safety of B-cell therapies in IgAN

https://t.co/hjjfo3oUtA

#ERA26

[Bret Scher, MD @bschermd]

Cardiology calls statins miracle drugs. Social media calls them poison.

Both sides cite published scientific papers. How can they be looking at the same evidence and reaching opposite conclusions?

As a cardiologist, I think both sides are are on to something. Let me explain. 🧵

[Scott Isaacs @scottisaacsmd]

SURPASS‑EARLY evaluated starting tirzepatide early in type 2 diabetes vs. conventional step-therapy. In adults with early T2D on metformin, tirzepatide produced larger 2‑year reductions in HbA1c, weight, and waist circumference than intensified conventional care, and more participants achieved normoglycemia. Although the open‑label design can introduce reporting bias and patients with very high baseline HbA1c (>9.5%) were excluded, the findings support considering GLP medications earlier to establish better and potentially more durable glycemic control than stepwise conventional care.
https://t.co/RnDtoMyzWg

[Crémieux @cremieuxrecueil]

This is pretty awesome.

Basically, they're creating a whole journal that's dedicated to post-publication peer review: criticizing papers after they're published in another venue.

A lot of papers need this because so many are horrendously bad.

I hope this succeeds!

[Juan Manuel Mejía @Meyaix]

eGFR slope has not been widely evaluated as surrogate outcome in #LupusNephritis. Post-hoc BLISS-LN analysis, belimumab + MMF showed protective effects on eGFR slope from weeks 24–104, supporting prior reports on kidney function preservation @Kidney_Int https://t.co/0mpHSZBxU4

[Marta Cobo Marcos @MartaCoboMarcos]

📢Very important and timely subanalysis of CLOROTIC. The addition of Hydrochlorothiazide to loop diuretics increased📈diuretic response irrespective of baseline Cl in AHF. @ICardiacaSEC @CardioRenalSEC @IcyfaSemi

[Scott Isaacs @scottisaacsmd]

TRIUMPH-1, the pivotal phase 3 obesity trial for #retatrutide, demonstrates some of the most substantial weight-loss outcomes ever reported with an anti-obesity medication. I am honored to comment for @EndocrineToday.
https://t.co/RUKwFobvSw

[Adrian Covic @accovic]

Implementing the commitments of the World Health Assembly kidney healt... https://t.co/VwyjwWac6y

[Daniel Coyne @DrDanMO]

BTK inhibitors for primary membranous nephropathy (pMN) with anti-PLA2R.
BTK inhibitor, EVER001, targets B-cell signaling to block autoantibody production. Trial data show >50% proteinuria reduction sustained off-treatment.

[Jonathan Chávez @JonathanNefro]

Con lesión renal aguda, al combinar las métricas de la TFGe cinética y la excreción tubular de urea, se discrimina bien quién iniciará diálisis en los siguientes días, con certeza ~85%

Evalúa 2 funciones fisiológicas renales distintas

Critical Care 2026
https://t.co/potTceIitL

[Brendon Neuen @brendonneuen]

New analysis of the ASCEND-ND trial:

Iron deficiency defined by low TSAT, but not low ferritin levels, is associated with increased risk of heart failure and cardiovascular death in CKD, independent of hemoglobin.

New in #EJHF: https://t.co/H93GdkCEsT

[Joel M. Topf, MD FACP @kidney_boy]

Do you remember when CONFIDENCE came out and it was surprising that there was no signal for improved hyperkalemia with the combination of finerenone and empa?

[Avi Roy @agingroy]

14 clinical trial arms. Three pharma companies. Three separate mechanisms. One question. Can you lose weight on Ozempic or Mounjaro without losing muscle?

Lose a kilogram on semaglutide (Ozempic) alone and roughly a third of it is muscle. On tirzepatide (Mounjaro), about 30%. This has been the cost of every obesity drug, diet, and bariatric surgery for decades. Your body doesn't spare muscle during a caloric deficit.

@Regeneron went after myostatin directly. Their antibody trevogrumab, combined with semaglutide in the COURAGE trial (999 patients, 26 weeks), shifted the fat share of weight loss from 67% to 83%. Adding garetosmab, which blocks activin A, pushed it to 92.6%. That three-drug combo lost more total weight than semaglutide alone, and nearly all of it was fat.

@ScholarRock took a narrower path. Apitegromab blocks only the latent form of myostatin. Combined with tirzepatide in EMBRAZE (87 patients, 24 weeks), fat share went from 70% to 85%.

@EliLillyandCo's bimagrumab is the broadest weapon. It blocks the receptor that both myostatin and activin A signal through. In the BELIEVE trial (507 patients, 48 weeks, @NatureMedicine 2026), 92.9% of weight lost with semaglutide was fat. And as a single drug, bimagrumab did something no obesity therapy has ever done. Patients lost weight while gaining 2.5% lean mass. Every gram of weight lost was fat.

The range across all 14 arms runs 67% to 100% fat. Every combination beat every GLP-1 alone. Didn't matter which antibody, which GLP-1, or which company ran the study.

The safety questions are OK. COURAGE's three-drug combo had a 28% dropout rate and 2 deaths. Bimagrumab triggers muscle spasms in many patients. Apitegromab looked cleanest but had the smallest trial.

More than 11 million Americans are on a GLP-1 right now. Most of them are losing muscle they'll struggle to rebuild, especially over 50. These drugs don't just shrink you. They decide what kind of weight you lose.

[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

[Dr. Hardik Patel 🩺💉 @hardik4u24]

🫘FSGS “one lesion = one treatment”

🚀Emerging biomarkers reveal distinct biology:
🔹suPAR → podocyte injury
🔹MCP-1 → inflammation
🔹CXCL10 → JAK-STAT
🔹BAFF/APRIL & anti-nephrin Ab → autoimmunity
🔹CLCF-1 → permeability factor

🔗 https://t.co/oez8AoVue1 🆕

[Gad Saad @GadSaad]

Well said.