Prince Singh, MBBS, FASN, FACP

Theology and Nephrology Chaser Nephrologist at Allina Health Consultancy for fun

[Prince Singh, MBBS, FASN, FACP @mayosingh]

Explore the diagnostic algorithm for the metabolic/kidney stone disease- Primary Hyperoxaluria (PH) for the 3 known types of PH with a case report describing kidney failure in a relatively young PH3 patient.

[AJKD @AJKDonline]

Primary Hyperoxaluria Type 3 Can Also Result in Kidney Failure: A Case Report

https://t.co/mLp1lrLLST

@mayosingh @candacegranberg @lieske_john @MayoClinicNeph

#hyperoxaluria #kidneyfailure

[Prince Singh, MBBS, FASN, FACP @mayosingh]

A well-balanced article (NYTimes) on weight loss drugs- I would prefer calling them GLP-1 agonists as their effects is not just manifested on loss of weights among users.

There was not much additional information on NAION (non-arteritic anterior ischemic optic neuropathy) associated with GLP-1 use- most of the earlier reports come from Europe.

What We Know About Weight-Loss Drugs Is Rapidly Changing https://t.co/rIXWbGR9RN

[Prince Singh, MBBS, FASN, FACP @mayosingh]

Pleasantly surprised to see Nephrology recognized among the specialties with the lowest rates of physician burnout.
According to recent data, the specialties with the lowest burnout rates are:
• Infectious Diseases – 23.3%
• Ophthalmology – 25.8%
• Pathology – 28.3%
• Nephrology – 29.3%
• Dermatology – 31.5%
• Psychiatry – 31.6%

As a nephrologist, this makes sense to me. Nephrology offers a unique blend of inpatient care, ICU medicine, outpatient clinics, and dialysis rounds.
That variety may actually serve as a built-in mechanism against burnout — rotating between different clinical environments keeps the work intellectually engaging and professionally fulfilling.

For internal medicine residents, trainees, and medical students:
If you enjoy diagnostics, physiology, pharmacotherapeutics, and continuity of care, nephrology is a deeply rewarding lifelong career to consider.

These 9 physician specialties report highest burnout rates | American Medical Association

#Nephrology #KidneyDisease #InternalMedicine #MedicalEducation #PhysicianWellness #Healthcare

[Prince Singh, MBBS, FASN, FACP @mayosingh]

Membranoproliferative Glomerulonephritis Due to Cryoglobulinemia | New England Journal of Medicine https://t.co/bM2fHObIEX

Membranoproliferative Glomerulonephritis (MPGN): A Pattern, Not a Diagnosis

One of the most important conceptual shifts in nephrology is understanding that MPGN is not a disease entity—it is a morphologic pattern seen on kidney biopsy.

Historically classified into subtypes, MPGN is now approached based on underlying pathophysiology, not just histology.

🔬 So what should clinicians do when MPGN is reported?

1. Start with immunofluorescence (IF):
This is the key step that directs further evaluation.
Immunoglobulins + complement present → Immune complex–mediated MPGN

C3 dominant staining → Think C3 glomerulopathy
2. If immune complex–mediated: dig deeper

Monoclonal restriction? → Evaluate for underlying hematologic disorders

Polyclonal deposits? → Consider:
Chronic infections (especially hepatitis B/C)
Autoimmune diseases (e.g., lupus, Sjögren’s)
Occult malignancy
3. If C3 dominant:

Evaluate for complement dysregulation (C3 glomerulopathy)
⚠️ Clinical Pearl:
Not all “MPGN-like” patterns are true MPGN. Conditions such as thrombotic microangiopathy (TMA) can mimic this pattern but represent a completely different disease process.
💡 Take-home message:
A biopsy diagnosis of MPGN should trigger a systemic workup, not conclude it. The kidney is often the “victim organ,” not the primary problem.

#Nephrology #KidneyDisease #Pathology #MedicalEducation #InternalMedicine

[Prince Singh, MBBS, FASN, FACP @mayosingh]

Ozempic Pen

Use: GLP-1 for Type 2 diabetes

TrumpRx price: Starting at $199.00

Original price: $1,027.51

36. Wegovy Pen

Use: GLP-1 for weight loss

TrumpRx price: Starting at $199.00

Original price: $1,349.02

[Prince Singh, MBBS, FASN, FACP @mayosingh]

The 43 medications on TrumpRx
https://t.co/S3ZB8XRVFL

Notable mentions:
Farxiga

Use: Type 2 diabetes, heart failure and CKD (SGLT2 inhibitor)

TrumpRx price: Starting at $181.59

Original price: $377.82

Insulin Lispro

Use: Rapid-acting insulin for diabetes

TrumpRx price: Starting at $25.00

Original price: Not listed

37. Wegovy Pill

Use: Oral semaglutide for weight loss

TrumpRx price: Starting at $149.00

Original price: $1,349.02

42. Zepbound

Use: Weight loss (tirzepatide)

TrumpRx price: Starting at $299.00

Original price: $1,087.00

[Prince Singh, MBBS, FASN, FACP @mayosingh]

😂😂😂

[Vala Afshar @ValaAfshar]

The Peter Principle is the satirical theory that employees are generally promoted to their level of incompetence.

In 1974, the author of the Peter a principle, Dr. Laurence J. Peter, explained how he first got the idea and what can be done about it

[Prince Singh, MBBS, FASN, FACP @mayosingh]

We are clearly living in the GLP-1 era — or perhaps more accurately, the GLP-1/GIP era.

It’s no coincidence that Novo Nordisk (NVO) and Eli Lilly (LLY) are reporting earnings today. Yet the market reaction couldn’t be more different: Novo Nordisk is down sharply in pre-market trading, while Eli Lilly is up meaningfully.

Why the divergence?

Eli Lilly has demonstrated extraordinary execution and demand concentration. More than 50% of its revenue is now driven by a single molecule — tirzepatide — marketed as Mounjaro and Zepbound, underscoring both the clinical impact and the commercial power of GLP-1/GIP dual agonists.

But the ripple effects of this therapeutic revolution extend far beyond pharmaceuticals.

Consider Chipotle Mexican Grill (CMG). With a softer forward revenue outlook and a stock down roughly 30% over the past year, it’s tempting to view this not just as a company-specific issue, but as part of a broader secular shift. These agents are quietly — but profoundly — changing how people eat, consume, and live.

GLP-1s are no longer just weight-loss drugs.
They are economic forces, reshaping industries from healthcare to food to consumer behavior.
And we are likely still early in this transformation.

[Prince Singh, MBBS, FASN, FACP @mayosingh]

Well balanced, very well written review on cardiogenic shock with excellent references cited for the review.

Cardiogenic Shock | New England Journal of Medicine https://t.co/FZRTIy6zH2

[Prince Singh, MBBS, FASN, FACP @mayosingh]

In the beginning was the Word, and the Word was with God, and the Word was God. He was in the beginning with God.

All things came into being through Him, and apart from Him nothing came into being that has come into being. In Him was life, and the life was the Light of men.

The Light shines in the darkness, and the darkness did not comprehend it.

[Prince Singh, MBBS, FASN, FACP @mayosingh]

@IsraeliPM I love, support and pray for nation state of Israel!!

[Prince Singh, MBBS, FASN, FACP @mayosingh]

F.D.A. Approves New Weight-Loss Pill https://t.co/5zkQHwtEzq

[Prince Singh, MBBS, FASN, FACP @mayosingh]

https://t.co/5Gf201E4kp

[Prince Singh, MBBS, FASN, FACP @mayosingh]

F.D.A. Approves New Weight-Loss Pill

The Food and Drug Administration has approved a pill version of the blockbuster weight-loss drug Wegovy, offering an option for patients who are hesitant or uncomfortable with injections.

The oral formulation contains a substantially higher dose of semaglutide—the same active compound found in Wegovy and Ozempic—because only a fraction of the drug is absorbed when taken by mouth compared with injection.

While oral semaglutide is not entirely new (the diabetes medication Rybelsus is already available), its maximum dose is 14 mg. In contrast, the maintenance dose of the Wegovy pill is 25 mg, which helps explain why weight loss with Rybelsus has generally been more modest than with injectable Wegovy or Ozempic.

The pill must be taken first thing in the morning on an empty stomach, with no food or drink for at least 30 minutes afterward.

In clinical trials, the side-effect profile was similar to that seen with injectable formulations. About 74% of participants taking the pill experienced gastrointestinal side effects, compared with 42% in the placebo group.

https://t.co/3j0LknGeBw

[Prince Singh, MBBS, FASN, FACP @mayosingh]

@khaledshawwa Agreed! But don’t expect that the best and brightest are joining us which means less innovation and discovery

[Prince Singh, MBBS, FASN, FACP @mayosingh]

🚨 2025 Subspecialty Match Results: A Wake-Up Call for Nephrology
On December 3, 2025, the National Resident Matching Program released the fellowship match results for internal medicine subspecialties. While many disciplines once again filled nearly all their positions, nephrology’s numbers are deeply concerning and highlight a critical challenge for the future of kidney care in the United States.
📉 The 2025 Nephrology Match in Numbers
193 nephrology training programs participated
Only 89 programs filled completely
Of 501 fellowship positions, only 333 were filled
168 positions — one out of every three — went unfilled
These results place nephrology at the very bottomamong all major internal-medicine subspecialties in terms of applicant interest. In contrast, cardiology, gastroenterology, pulmonary/critical care, and hematology-oncology all continued to fill nearly 100% of their slots.
💡 Why This Matters
The implications go far beyond the match cycle:
The CKD and ESKD population continues to grow, yet fewer trainees are entering the field.
Many communities — especially rural and underserved regions — already face nephrologist shortages.
Advances in transplant immunology, glomerular therapeutics, cardiorenal medicine, and acute dialysis technology highlight how rapidly the field is evolving — but interest from trainees is not keeping pace.
Persistent concerns about workload, call burden, and compensation likely continue to influence career decisions among residents.
🔎 A Call for Reflection
These data should prompt serious reflection across academic centers, professional societies, and healthcare systems. Improving early exposure to nephrology, restructuring clinical workloads, modernizing fellowship training, and addressing compensation disparities will be essential if we want to sustain a robust kidney workforce for the next generation.
💬 Final Thought
The story that the 2025 match tells is clear:
Without strategic changes, the future supply of nephrologists may not meet the growing demand for kidney care.

[Prince Singh, MBBS, FASN, FACP @mayosingh]

Sen. Bill Cassidy (R-Louisiana), the chairman of the Senate’s health committee, on Monday sent the American Medical Association a list of questions about how the lobbying group devises codes that are used to bill for medical procedures and services, fees associated with that work and the organization’s broader agenda.

The letter, which was shared with The Washington Post, escalates efforts Cassidy made in October to penetrate what he and others deemed an opaque process with outsize influence over the U.S. health care system. Then, Cassidy received answers he deemed insufficient.
The association did not immediately respond to questions about criticism of its coding system, known as the Current Procedural Terminology, or CPT. An AMA official said the association planned to respond to Cassidy’s requests.https://t.co/yLUD2gL6U2

[Prince Singh, MBBS, FASN, FACP @mayosingh]

The extent and depth of corruption at the Minnesota state level is astounding!! Its not that criminals defrauded tax payers of billion of dollars (which in and of itself is punishable by law and is theft) but the people in charge and the helm (Governor Tim Walz) did not do anything about this. The corruption was so rampant that whistle blowers even reached out to Kamla Harris at the striking passivity of the head of the state (Walz) but again no action was taken and as NYTimes suggest it was due to fear of being labelled racist📷

How Fraud Swamped Minnesota’s Social Services System on Tim Walz’s Watch

https://t.co/O9Te3KKAB8

[Prince Singh, MBBS, FASN, FACP @mayosingh]

@SeeFisch @ sorry but not true! Many of our doctors including this one did NOT came as an asylum seeker!