Eva Gómez Flores

Nefrología HUGCDN

[Mario Jimenez MD. PhD @DrMarioJimenez1]

🔔 ¿Seguimos esperando a que la creatinina sérica suba para diagnosticar una Lesión Renal Aguda?

Llegamos tarde.
La línea de tiempo conceptual presentada en el #ERA26 demuestra que la creatinina y la caída del volumen urinario son marcadores de disfunci��n clínica tardía, no de daño temprano.

El estrés renal inicia mucho antes con la parada del ciclo celular, detectable inmediatamente tras el insulto mediante biomarcadores ultrasensibles como TIMP-2 e IGFBP7.

Cambiar nuestra mentalidad del diagnóstico funcional al molecular es imperativo para la nefroprotección crítica.

#Nefrología #MedicinaCrítica #ERA26 #AKI #NefroTwitter
#lesionrenalaguda #dañorenal #IRA #AKI

[Raquel Barba Teba 🦋 @DrBarbaTeba]

#ERA26
🚨Results of the study:
🍀HDx was non-inferior to OL-HDF for a composite cardiovascular outcome and showed similar safety and mortality profiles.
🍀HDx presents as an alternative to OL-HDF in settings where optimal convective dosing cannot be consistently achieved

[Raquel Barba Teba 🦋 @DrBarbaTeba]

One of the most awaited talks for this #ERA26
MOTheR HDx Study: A MOPR Study to Explore Morbidity and Mortality in Patients Dialyzed with Theranova HDx Compared with OL-HDF

🗣️ @DePsequera

[ERA - European Renal Association @ERAkidney]

Late breaking clinical trials 2:
The Use of Rituximab In the treatment of Nephrotic Glomerulonephritis (TURING): a multicentre, double-blind, randomised, placebo-controlled trial
By Lisa Willcocks (Cambridge, UK) &
Megan Griffith @megan_griffith1 (London, UK)
#ERA26

[Abdelhamed Hamdy @Abdelhamed6261]

#ERA26
Rituximab in MCD/FSGS

[Mónica Furlano MD, PhD @m_furlano]

#Finerenone in Chronic Kidney Disease without diabetes:
⚖️This could be valuable in #CKD and rare or #genetic kidney diseases

https://t.co/XspG0bfwbE

[Abdelhamed Hamdy @Abdelhamed6261]

#ERA26 anti Nephrin antibodies in Podocytopathies

[ERA - European Renal Association @ERAkidney]

Starting strong with controversies in nephroprotection #ERA26

@jjcarrero1 talking about potassium 🍌🥑

📍Plant-rich diets do not inherently cause protein deficiency in CKD.
Plant phosphorus is less absorbable, so plant-based diets may ⬇️ phosphate burden despite similar phosphorus intake
📍The evidence supporting routine restriction of fruits and vegetables to prevent hyperkalemia is weaker than traditionally believed
📍Focus on food quality and individual risk, not automatic avoidance of plant foods.

[ERA - European Renal Association @ERAkidney]

3/ Role of parietal epithelial cells
⏩ Parietal epithelial cells act as podocyte progenitors
⏩ Females generate more podocytes throughout life.
⏩ Estrogens drive podocyte regeneration

[ERA - European Renal Association @ERAkidney]

⚠️The proximal tubular phosphate transporter Npt2a may be more than a phosphate carrier‼️

💡In experimental AKI, Npt2a inhibition ➡️

📌restored mitochondrial fusion,
📌improved mitochondrial function and
📌attenuated kidney injury,

This highlights a novel Npt2a–Klf15–mitochondrial axis.

#ERA26 #AKI #KidneyResearch

[ERA - European Renal Association @ERAkidney]

🧵—Open your mind: New therapeutic opportunities in inherited kidney diseases

#ERA26
@ERAKidney

1/🧵Overcoming Barriers in Rare Disease Drug Development
🗣️Speaker: Olivier Devuyst

1/ 💊 #ERA26
-Only a few rare genetic diseases have affordable treatment.
-Lysosomes are fundamental for cell cycling and promising targets for certain diseases.

[Francisco Valga, MD, PhD @Nefrogeek]

Presenting our work at #ERA26 with @EvaGomezFl

@ERAkidney @NefroNegrin @SENefrologia @senjoven

[Ivan Velázquez @Nephro_Ivan]

Excelente tabla que resume las causas celulares y moleculares (genéticas) de ERC de origen desconocido
🤓🤓👏🏻👏🏻👏🏻
@NEJM

[Nefrología HUGC Dr Negrin @NefroNegrin]

Orgullosos de la participación activa de nuestra Unidad de Trasplante en el Congreso SET 2026.

📍Adjuntos y residentes compartiendo experiencia, aprendizaje e investigación en uno de los principales encuentros nacionales sobre trasplante💙����

#SET2026 #Trasplante #Nefrología

[Joaquín Martínez @JMMR83]

Cuantificación de derrame pleural por ultrasonido.

[NephroPOCUS @NephroP]

#POCUS #echofirst answer: 1️⃣ Subxiphoid short axis view at the aortic valve level 2️⃣ RVOT Doppler

RVOT Doppler is one of the most underused but high yield tools.

● Tracks RV stroke volume and cardiac output
SV = CSA × VTI
CO = SV × HR
VTI alone works well for serial trends

● Estimates pulmonary vascular resistance
PVR = (TRV ÷ RVOT VTI) × 10 + 0.16

● Screens for pulmonary hypertension even when TR jet is absent
AccT <105 ms suggests PH
AccT ≤60 to 80 ms raises concern for acute PE

● Waveform shape gives physiology
Parabolic is normal
Early peaking and notching suggest rising PVR and help phenotype disease

● Distinguishes acute PE from chronic PH using AccT and notching patterns

● Provides insight into RV pulmonary arterial coupling
RVOT VTI ÷ PASP as a simple coupling metric

● Useful in congenital heart disease
Grading RVOT obstruction and serial follow up after repair

● Tracks response to therapy noninvasively over time

CWD complements PW when velocities are high

● Grades pulmonic stenosis using peak velocity and gradients
Severe if peak gradient >64 mmHg or velocity >4 m/s

● Estimates pulmonary pressures from PR jet
mPAP = 4(V peak PR)² + RAP
PAEDP = 4(V end diastolic PR)² + RAP

● Identifies multi level RVOT obstruction
Double contour envelope suggests infundibular plus valvular disease

● Detects dynamic RVOT obstruction
Late peaking dagger shaped signal

● Enables global RV performance assessment
Tei index combining TR and RVOT flow

● Monitors conduit or bioprosthetic valve gradients over time

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

🤓 AKI in the ICU is not just kidney failure.
It is a hemodynamic and congestion failure.

🚨 Reality check

👉 AKI occurs in:
▪️ 13-36% of acute HF patients
▪️ Up to 80% in cardiogenic shock

👉 Dialysis needed in up to 13%

👉 Strongly linked to mortality

⚠️ The key mistake

We treat AKI as a creatinine problem

💥 But it is actually:

👉 A perfusion + congestion problem

🧬 Core physiology

Renal perfusion pressure = MAP - CVP - IAP - airway pressure

📌 The nephron needs ≈ 40 mmHg to function

🔥 So what kills the kidney?

Not just low pressure

But:

▪️ Venous congestion (↑CVP)
▪️ Fluid overload
▪️ Intra-abdominal hypertension
▪️ Low forward flow

🧩 Step-by-step mindset

1️⃣ Confirm congestion
👉 JVP, no fluid responsiveness, VExUS ≥1

2️⃣ Optimize hemodynamics
👉 Maintain MAP ≥65 mmHg

3️⃣ Decongest
👉 Diuretics = cornerstone

4️⃣ Escalate
👉 CRRT if failure

📌 It’s a flow-pressure-congestion algorithm

💊 Pharmacology reality

❌ “Renal-dose dopamine” → useless AND harmful
❌ No drug prevents AKI

✔️ Loop diuretics → first-line
✔️ Sequential nephron blockade if resistance

⚡ Diuretic resistance = turning point

👉 Think:

▪️ Gut edema → poor absorption
▪️ Hypoperfusion
▪️ Tubular dysfunction

👉 Solutions:

▪️ Higher doses
▪️ Combination therapy (thiazides, acetazolamide)
▪️ Consider hypertonic saline strategy

🚨 CRRT is NOT first-line

👉 Indications = AEIOU:

▪️ Acidosis
▪️ Electrolytes
▪️ Intoxication
▪️ Overload
▪️ Uremia

👉 Early CRRT?

❌ No mortality benefit
✔️ Wait-and-see + optimize first

🧠 Advanced insight

👉 The kidney fails more from:

✔️ Congestion than hypotension
✔️ Venous pressure than arterial pressure

🔥 Take-home

AKI management in ICU is:

✔️ Hemodynamic
✔️ Congestion-driven
✔️ Stepwise

🚨 Final message

👉 Don’t chase creatinine
👉 Don’t reflexively dialyze

Treat:

Perfusion + Decongestion + Time

📚 Riccardi et al.
European Heart Journal Acute Cardiovascular Care, 2025
https://t.co/OLnrbCQ8Y2

[Dr. Jair Vargas @DrDeLaUCI]

LESIÓN RENAL AGUDA EN CIRROSIS ‼️

📌LRA en cirrosis ( Criterios KDIGO) :  

a) aumento de la creatinina sérica ≥0,3 mg/dl en 48 h o ≥50% del valor basal que se sabe o se presume que ocurrió en los 7 días anteriores y/o producción de orina ≤0,5 ml/kg durante ≥6 h

[S.E.N. Nefrología @SENefrologia]

🔴 ¡Empezamos con el Módulo 1️⃣!
➡️ Fundamentos de la Hemodiálisis▪️Principios biofísicos▪️Composición del líquido de diálisis ▪️Acceso vascular @EmiliSanAlv @mf_slon @DePsequera @Florijaviesther👇

[S.E.N. Nefrología @SENefrologia]

🔄 ACTUALIZADO en #Nefroaldía @nefroaldia
🥗 "Nutrición en Nefrología. Conceptos generales y estimación de los requerimientos nutricionales"
✍️ Por Pablo Molina @MolinaPab, Emma Huarte @emma_huarte y Macarena Arancibia
🔗 https://t.co/0HHR556aoT