Richard J. Glassock @GlassockJ Twitter profile

Last Seen Profiles

@The_Pulse_Clan

@leeewonhee

@AlhmyryAlm25008

@JuanPaDulanto

@_pupuwu

@Yatsuiichiro

@DravenNoctis

@atiselsts_eth

@_bossanova_

@Tobias1485056

@rajkumarsha1308

@hek8907

@chillichelli

@M33009696115

@spencermossy

@pandacapuccino

@1PlayboyAlpha

@Zetsu_Bou_God

@jjanaraa

@aitokyouki

@UptownBimbo

@ThorstenPolleit

@TrinityTigersB2

@YounisA24603694

@trang_menotti10

@Yarlens_Dei

@jgjgisnear

@sharoncowan22

@ProfSaunders

@Pistabacsi

@SUPERDOPEBRAND

@RetroTwinz

@GrYoungsteve

@zisaneysan

@LeclaireRobin

@gbosewo407

Richard J. Glassock

@GlassockJ

11 months

I see many tweets claiming that hypertension is a cause of CKD. This is a common error. It is far more likely that CKD is a cause of hypertension.

46

118

676

Richard J. Glassock

@GlassockJ

3 years

@krupali @kidneydoc101 @ReutersIndia This is a humanitarian crisis of un- imaginable severity. A global response is required . We must all, collectively, help the people of India cope and survive this tragedy.

2

22

161

Richard J. Glassock

@GlassockJ

5 years

I just celebrated my 2 year anniversary of joining Twitterdom. It has been very enjoyable, enlightening and eye-opening. I am still learning how to be an effective communicator and responsible Tweeter.

8

9

150

Richard J. Glassock

@GlassockJ

5 years

I just heard a wonderful lecture on AKI at the Cleveland Clinic Nephrology Update-2019. Conclusion - creatinine based classifications of AKI are an epidemiological construct having little value in decision making or clinical care in the ICU. A drastic change is needed.

4

38

150

Richard J. Glassock

@GlassockJ

2 months

@goKDIGO @Kidney_Int Disappointed that KDIGO decided against adopting an age-adapted threshold of eGFR for classifying/ diagnosing CKD. Many older people will be labeled as having CKD unnecessarily, IMO. Maybe the next iteration of these very important CPG will recognize/correct this oversight.

10

27

137

Richard J. Glassock

@GlassockJ

3 years

A diet rich in vegetables, fresh fruit and nuts bereft of red meat is a very attractive idea to prevent CVD and CKD- the problem is that this notion is based almost entirely on observational (potentially confounded) Data. Is it not time for a large well powered RCT?

21

25

129

Richard J. Glassock

@GlassockJ

3 years

Now we have RASi, SGLT2i and MRA. Will the prevalent counts of ESRD finally begin to fall?

15

16

118

Richard J. Glassock

@GlassockJ

4 years

Hats off to Drs. Tonelli and Dickinson (JASN 2020;31:1931-1940) who have written what may arguably be the best critical analyses of early detection of CKD yet published. It should be required reading before embarking on any effort to detect CKD by screening or case-finding.

3

15

111

Richard J. Glassock

@GlassockJ

5 years

It is now “official- “Contrast-induced Nephropathy” (CIN) has morphed into “Contrast-associated Nephropathy” (CAN). See Annals for Hospitalists- July, 2019).

5

46

111

Richard J. Glassock

@GlassockJ

3 years

It is so frustrating to read posts on Twitter describing that something is linked to something else tacitly suggesting a causal relationship when we all know that association (correlation ) is not equivalent to causation. Most associations in fact are non-causal and coincidental

3

17

108

Richard J. Glassock

@GlassockJ

3 years

2020 has been a really tough year for a lot of people throughout the world. We need to acknowledge their suffering and loss, as we look forward to a New Year full of promise and hope . May 2021 bring us the relief we so desperately need.

5

6

103

Richard J. Glassock

@GlassockJ

4 years

What a wonderful experience. NephMadness is a gift that keeps on giving. It provided solace and enjoyment while realizing that the world was changing around us, perhaps for decades to come. Many thanks to the BRP, Bloggers and the organizers

3

6

102

Richard J. Glassock

@GlassockJ

3 years

How many antigen-antibody systems are involved in the pathogenesis of Membranous Nephropathy in humans? I have lost count- but the modifying terms “Primary” and “Idiopathic” no longer seem very relevant. A new system of nosology will evolve, and very soon, I predict.

3

11

100

Richard J. Glassock

@GlassockJ

5 years

@AmeetRKini @S_brimble What a great pictorial representation of the implicit truth of this often repeated adage!! Observational data gatherers and analysts beware. A hypothesis generated is only a half-way message.

0

91

Richard J. Glassock

@GlassockJ

4 years

Great things have come from the COVID 19 disaster- the inspiring image of Dr. Fauci and the selfless heroics of our health care professionals. Bravo! I predict an upswing of interest in Doctoring/Nursing as careers in the coming years from these memorable examples.

3

10

95

Richard J. Glassock

@GlassockJ

1 year

@MAstronomers Imagine , the “message” began its journey 4 Billion years before the Earth was formed from dust around the Sun.

3

0

88

Richard J. Glassock

@GlassockJ

4 years

A “game-changing “ paper published today (Brown JM et al, Ann Intern Med)strongly suggests that Paldo and ARR testing for Primary Aldosteronism should be abandoned -replaced by a new paradigm of evaluation for a disorder that is much more common than generally appreciated.

5

24

87

Richard J. Glassock

@GlassockJ

1 year

Several posts have suggested that eGFR -Cystatin C has superior accuracy compared to eGFR-creatinine (race-free 2021 equation) for assesment of true measured GFR. Not true in white Americans. See Delanaye P et al NEJM, 2023. Combination of eGFR-creat + eGFR-Cystatin C is best.

5

13

86

Richard J. Glassock

@GlassockJ

2 years

Happy New Year !!! May this year be full of joy, peace and safety from the ravages of COVID.

3

85

Richard J. Glassock

@GlassockJ

4 years

Relaxing in the SkyClub at DCA and reflecting on the ASN meeting. It was a very good meeting -A+ for novelty and the enthusiasm for “change” in the stale field of ESRD therapy was palpable. Lots of hope- but can this energy be channeled to obtain tangible results? We shall see!

6

4

80

Richard J. Glassock

@GlassockJ

5 years

Twitter is very good for dissemination of knowledge, both old and new, but IMHO it falls short in providing good, valid, unbiased critical analysis of the knowledge that is shared. This is OK if the reader is aware of this inherent deficiency.

7

12

82

Richard J. Glassock

@GlassockJ

3 years

Proteinuria from tubule dysfunction (e.g. Dent Disease) consists of LMW proteins, but albuminuria is also present as a low proportion of total protein excretion, usually about 10-30%. Normal albumin (<10mg/d) + elevated total protein excretion equals LMW overflow proteinuria.

3

18

79

Richard J. Glassock

@GlassockJ

2 years

Just wondering- since the renoprotective benefits of SGLT2i are at least partially dependent on the magnitude of proteinuria ( with a possible upper threshold of 5gms/d) what is the evidence that they are usefully renoprotective in chronic tubulo-interstitial kidney disease?

14

5

73

Richard J. Glassock

@GlassockJ

4 years

The very large, observational study of efficacy and safety of various first-line choices of pharmacotherapy of newly discovered hypertension (LEGEND study) is out. (See Suchard MA, et al Lancet 2019; 394: 1816-1826). Thiazides win, hands down.

3

35

76

Richard J. Glassock

@GlassockJ

3 years

Should we be “flozinating” more patients with Primary IgAN who fail to achieve proteinuria targets with RASi alone? DAPA-CKD certainly makes this question relevant to therapeutic decision making in this frustrating disorder.

12

7

69

Richard J. Glassock

@GlassockJ

5 years

Maybe the time has come to formally test the hypothesis that incremental hemodialysis designed to slow the rate of loss of RRF yields superior long-term patient-centered outcomes compared to longer/more frequent hemodialysis designed to achieve euvolemia early and continuously.

3

20

70

Richard J. Glassock

@GlassockJ

2 years

Is GLP1RA + SGLT2i the new “standard of care “ for initial therapy of T2DM with or without abnormal albuminuria? Not according to ADA/KDIGO. Cost effective compared to Metformin?

5

12

67

Richard J. Glassock

@GlassockJ

4 years

@EricTopol @medicalaxioms @POTUS I am really tired of seeing unsubstantiated claims of efficacy and safety of HCQ for COVID- 19 on Twitter . It is time to declare a moratorium on such posts, until we have some clear evidence, one way or the other.

7

64

Richard J. Glassock

@GlassockJ

4 years

My experience with MCD and severe acute onset of Nephrotic Syndrome has convincedled me that the risk of VTE is increased. I suggest short term anticoagulation (with sq heparin and/or warfarin ) until a remission has been obtained, especially if other VTE risk factors are present

1

14

64

Richard J. Glassock

@GlassockJ

4 years

An intentional lie can begin to sound like the truth, if it is repeated often enough. Just an opinion.

5

11

62

Richard J. Glassock

@GlassockJ

5 years

Independent confirmation is the essence of science. With only 50% of studies reported in the literature confirmed by subsequent studies, I think one should have a healthy skepticism concerning individual reports and suspend judgement until such validation is obtained.

5

28

61

Richard J. Glassock

@GlassockJ

4 years

In my opinion, advertisements on TV that show individuals not wearing masks, gathering in groups without adhering to social distancing rules or other behaviors discouraged by public health authorities should be banned.

2

7

60

Richard J. Glassock

@GlassockJ

2 years

The RCT of steroids for IRGN by Arivashagan S et al (Ki Reports, 2022) is a very welcome publication. Unfortunately, it was underpowered, had a high recovery rate (88%) in the untreated arm, was imbalanced at entry concerning crescents and had no patients with endocarditis.

4

8

58

Richard J. Glassock

@GlassockJ

4 years

@NephRodby P-ANCA is troubled by false-positives- one should really test with antigen-speficic tests (anti-MPO/anti-PR3) and abandon ANCA testing by IIF altogether, in my opinion.

2

7

57

Richard J. Glassock

@GlassockJ

5 years

@VelezNephHepato @nkf I agree with your advice. What a wasted consultation. CKD G3A:a1 in a 90 year old is not a disease, it is normal physiological aging. KDIGO needed to age-adapt their definitions of CKD.

6

7

57

Richard J. Glassock

@GlassockJ

5 years

The debate about the impact of a low protein diet on the rate of progression of CKD continues without a clear resolution- but broad agreement exists that such diets, when rigorously adhered to, can safely delay the need for dialysis based on “uremic” symptoms.

3

19

55

Richard J. Glassock

@GlassockJ

5 years

Are Textbooks passé in medical education? Will the internet and social media replace them? Should books be online only or are hard-copies still relevant? I wonder about these things when I am asked to write a Chapter for a book.

27

9

53

Richard J. Glassock

@GlassockJ

3 years

The creative scholarship, humanity and mentorship of the now departed and legendary Robert Schrier, MD will be long remembered

1

4

54

Richard J. Glassock

@GlassockJ

5 years

How was the diagnosis of Primary (AL) Amyloidosis established? The new “gold standard” for diagnosis of Amyloidosis and its subtypes is Laser Dissection- Mass Spectrometry. LM (Congo Red stain), EM and even IF can be potentially erroneous.

1

16

54

Richard J. Glassock

@GlassockJ

5 years

Went shopping at Costco yesterday. Large containers of powdered and liquid Turmeric on several aisles. Came home to see TV ads for Turmeric. Is an “epidemic” of oxalate Stones/Nephropathy in the offing?

9

11

54

Richard J. Glassock

@GlassockJ

5 years

@Neph_Sim This poll cannot be answered as shown as all of the “diseases” have been associated with hypocomplementemia. Also MPGN is not a disease, it is a histopathological “pattern of injury”. Back to the drawing board.

4

2

53

Richard J. Glassock

@GlassockJ

4 years

I read the CKD-FIX -NEJM report again (perhaps more carefully). It is not a “perfect” RCT, but few are. The early termination due to slow enrollment/higher than expected drop outs is disappointing but viewed with the PERL+Febuxostat trials, it is still pretty convincing.

1

12

52

Richard J. Glassock

@GlassockJ

3 years

@askrenal @NephJC @WaliNuri @edgarvlermamd @escardio We call it Lasix because its effects last for 6 hours. Once daily Lasix is ineffective because soon as the effects are over compensatory sodium avidity kicks in returning sodium balance to zero. It is not the Plasma Lasix Level that counts, it is the level in the tubule lumen.

3

9

52

Richard J. Glassock

@GlassockJ

2 years

@NephRodby @scoca1 @kidney_boy @Jwaitz @hswapnil @VelezNephHepato The NSAID prohibition has been advocated for decades by “official Nephrology” based on very very shaky evidence. Short term use in moderate dosage for symptomatic relief is just fine, in my opinion.

0

5

51

Richard J. Glassock

@GlassockJ

5 years

The supposed excess power of social media has become a cause celebres. In my own recently acquired exposure to SoMe, I am struck with its overt self-congratulatory tone. To me, an issue is how can this societal neo- structure develop a rigorous self-critical component.

6

17

51

Richard J. Glassock

@GlassockJ

3 years

Manns et al (BMJ, 2010) found that population screening for CKD using eGFR was not cost-effective for the elderly and those with non-Diabetic hypertension. These findings need to be re-examined in light of the efficacy of SGLT2i (added to RASi) for prevention of progressive CKD.

3

8

50

Richard J. Glassock

@GlassockJ

2 years

Serum Cystatin C (and thereby eGFR-Cystatin C ) “predicts “ CVD better than Serum Creatinine (and thereby eGFR-Cr) mostly for non-GFR related reasons. eGFR -Cystatin C is no more accurate than eGFR- creatinine for “predicting “ measured GFR.

5

9

49

Richard J. Glassock

@GlassockJ

2 years

@cavanaugh_do @hswapnil @askrenal @AskRenalPath For lack of a better terminology, I would call it “Sero-negative, renal limited Lupus-Like Membranous Nephropathy “ and manage it as if it was pure Class V Lupus Nephritis. Without EXTI/II + not a benign disease. Treatment should be given, but the optimal regimen is uncertain.

4

2

48

Richard J. Glassock

@GlassockJ

2 years

What are the modifiable risk factors that been proven to be causal for incident CKD, other than Diabetes and Obesity? The answers to this question are crucial for public policy and individual behavior changes designed to reduce the burden of CKD through preventative measures

16

6

46

Richard J. Glassock

@GlassockJ

1 year

@Renaltubules No- this is not a frequent phenomenon so early but up to 40% of young children with MCD will undergo a spontaneous remission within 1 year of onset. What is even more interesting is that such spontaneous remissions seldom (<10%) subsequently relapse..

0

5

47

Richard J. Glassock

@GlassockJ

5 years

@kamkalantar Remember - SGLT2 inhibitors are not designed to replace RASi- they are meant to complement the effects of RASi on Overt Nephropathy in T2DM.

4

8

47

Richard J. Glassock

@GlassockJ

4 years

I just watched an “expert” on TV suggesting annual physical exams should continue during the COVID19 era. Such statements are an anachronism and surely bad advice, IMO .

2

6

47

Richard J. Glassock

@GlassockJ

1 year

@kidney_boy @VelezNephHepato That statement that an eGFR of 45-59ml/min/1.73m2 in a subject with no abnormal albuminuria who is over 65 years of age is equivalent to chronic kidney disease may be one of the most common fallacies in clinical nephrology .

2

8

46

Richard J. Glassock

@GlassockJ

4 years

COVID19 is the disease (like AIDS). The virus that causes the disease is SARS-CoV-2 (like HIV).

0

13

45

Richard J. Glassock

@GlassockJ

2 years

I am biased , of course, but the leading Nephrology non-society based Journal (American Journal of Nephrology) does a very good job with peer -review (timely, rigorous, fair, helpful). Thanks to Editor- in- Chief, Dr. George Bakris.

2

1

44

Richard J. Glassock

@GlassockJ

5 years

@hswapnil CREDENCE is a HUGE game-changer in management of Diabetic Kidney Disease (DKD). Where do we go from here? A new standard-of-care has emerged. Future trials must be judged against this new Standard. Think about this and how it will influence clinical trials in DKD going forward.

0

16

45

Richard J. Glassock

@GlassockJ

2 years

@LangoteAmit @drmanishasahay @NephRodby @AyoubIsabelle @IgAN_JBarratt @hswapnil @MayuriTrivedi80 @raja_1980 @VijayKher8 @vjha126 Yes, IgAN has a predilection to be associated with “malignant hypertension”. This was first noted by Australian Nephrologists in the 1970’s. (Clarkson A, et al Clin Nephrol, 1977) Fortunately, it is rather uncommon, seen in about 8% of cases.

0

10

44

Richard J. Glassock

@GlassockJ

5 years

@womeninnephro @rheault_m @ERAEDTA @ynptweets It took the ASN 43 years to elect its first Woman President (Sharon Anderson, 2009). I am proud to say that the Women in Nephrology organization was founded during my ASN Presidency in 1983-1984..

3

11

43

Richard J. Glassock

@GlassockJ

3 years

@mitemadog @rheault_m Fong Disease ( Nail Patella Syndrome). Probably also present in one of her parents. Very mild phenotype.

0

3

42

Richard J. Glassock

@GlassockJ

4 years

@WHO @pahowho @WHO_Europe @WHOEMRO @WHOAFRO @WHOSEARO @WHOWPRO Despite the double negative, if you read the entire statement the gist of the recommendation can be understood. It is OK to use Ibuprofen if no other contra-Indications exist. Based on available information, this seems to be very reasonable.

1

5

41

Richard J. Glassock

@GlassockJ

4 years

What is the evidence that patients on center-based HD have increased risk of acquiring SARS-CoV-2 infection (other than the proximity factor) and are at increased risk for a more severe COVID-19? If cytokine storm is a cause of mortality then the disease might be less severe.

8

7

40

Richard J. Glassock

@GlassockJ

3 years

@MunerMohamed1 @OchsnerNephro Shouldn’t every Nephrologist’s office be equipped with a centrifuge, pipettes, Sternheimer-Malbin stain, glass slides/coverslips and a good microscope, fitted with Phase Contrast, Dark-field and Polarizing optics?

6

3

41

Richard J. Glassock

@GlassockJ

3 years

Question- How much of the association between high vegetable intake and lower incident CKD is the result of lower intake of creatinine and thus a lower serum creatinine for any given value of measured GFR?

2

1

42

Richard J. Glassock

@GlassockJ

2 years

How strong is the evidence that a reduction in NaCl intake will prevent the development of incident CKD?

12

41

Richard J. Glassock

@GlassockJ

2 years

Is the fraction of an infusion of Rituximab excreted in the urine greater in a patient with Nephrotic Syndrome due to Membranous Nephropathy than in a patient with a similar degree of Nephrotic Syndrome due to Minimal Change Disease?

5

12

41

Richard J. Glassock

@GlassockJ

2 years

@GarySingerMD @NephMadness @worldkidneyday @RPANephrology Many of those elderly patients with Stage 3A CKD (KDIGO definition) might be better off not knowing their CKD status. Just a contrarian opinion.

5

4

41

Richard J. Glassock

@GlassockJ

2 years

@kidney_boy CKD 3A without proteinuria in a subject over 65 years of age is typically not a real disease, just normal aging.

4

10

39

Richard J. Glassock

@GlassockJ

2 years

@raad_chowdhury @DrSS_neph @GlomCon @nephromythri @Jithukurian6 The distinction between Primary and Secondary MN has been blurred by recent information. We should probably abandon this now obsolete classification system and move to an antigen (not antibody) based classification system for MN lesions, IMHO.

2

4

40

Richard J. Glassock

@GlassockJ

2 years

Good news from the USPSTF. After a decade they are going to revisit recommendations for population based screening for CKD. Kudos to the NKF, ASN and the C4KH for bringing this issue to the forefront. Now we can await the findings and recommendations of the USPSTF.

1

3

37

Richard J. Glassock

@GlassockJ

6 months

@brendonneuen @CircAHA @mvaduganathan @ShelleyZieroth @hvanspall @GiuseppeGalati_ @ValleAlfonso @drpatrickholmes @drkevinfernando @pabeda1 @CristobMorales @ErinMichos Simply amazing! The frequency of dialysis/transplantation therapy for ESKD from DKD is going to dramatically decrease over the next few years , and the same is likely for non-DKD as well. Transformative development- Hooray !!!

2

3

40

Richard J. Glassock

@GlassockJ

1 year

@thenephrologist Any more current information relative to this claim?

4

0

32

Richard J. Glassock

@GlassockJ

3 years

Just curious- should we be using more direct renin inhibitors for treatment of IgAN, because of the C3 convertase-like actions of Renin? Evidence of benefit is suggestive but not definitive.

6

8

37

Richard J. Glassock

@GlassockJ

5 years

@SethiRenalPath Very exciting discovery-congratulations!!. Soon Idiopathic MN will be relegated to the museum of Medicine. Now we need a 3-antibody panel to diagnose (non-Idiopathic) Primary MN. The diversity of antigens involved in MN raises interesting questions on pathogenesis of MN.

0

2

37

Richard J. Glassock

@GlassockJ

4 years

The world is changing- BLM used to mean Bureau of Land Mangement , now it is Black Lives Matter. Change is in the air. Long overdue, in my estimation.

2

0

39

Richard J. Glassock

@GlassockJ

2 years

@JanSlapeta @Sydney_Uni The “in-person” lecture for medical students may be a dinosaur. But are the small group interactive sessions with Problem -based learning a satisfactory replacement? I do not think so. The decline of in-person lectures is a sign of serious problems in Medical Education, IMO.

3

38

Richard J. Glassock

@GlassockJ

4 years

Here is my (uninvited) take on cloth/paper surgical masks for “prevention” of COVID19 by the general public. They have very limited efficacy in prevention of newly acquired infection, but are useful for decreasing spread of an infection to others from a person already infected

1

12

37

Richard J. Glassock

@GlassockJ

4 years

@DrJMLuther @Nephro_Sparks @hswapnil @thebyrdlab @jordy_bc There has been no study showing that dual ACEi + ARB is harmful in young, non-Diabetic subjects with IgAN. The issue is efficacy and that requires a RCT. Absent a RCT, I will continue to use dual RASi in selected patients with IgAN and proteinuria resistant to RASi momotherapy.

5

9

37

Richard J. Glassock

@GlassockJ

4 years

@askrenal @NephJC @ThaerYassin Never make a decision about when to start kidney replacement therapy based on the plasma urea concentration alone, in my opinion.

3

2

36

Richard J. Glassock

@GlassockJ

2 years

@Tiff_Caza @arvindcanchi @raja_1980 @SethiRenalPath The Mayo Clinic Protocol for avoidance of unnecessary kidney biopsies in MN using anti-PLA2R testing (ELISA and IFA) is commonly misunderstood. False positive anti-PLA2R ELISA seem to occur in patients with Diabetic Nephropathy, for unexplained reasons. IFA testing is mandatory

0

8

37

Richard J. Glassock

@GlassockJ

4 years

@annmohare @anupamuab @rajmehrotra1122 @vjha126 Dr. Chugh had remarkable foresight and left an extra-ordinary legacy to India and the world though his trainees and acolytes. This is testimony to the impact that one gifted and passionate person can have on a profession and a culture.

0

14

37

Richard J. Glassock

@GlassockJ

2 years

@tulunsokit Yes, it is time to retire the term “Hypertensive Nephropathy “ as a clinical diagnosis for the cause of kidney failure .

4

5

37

Richard J. Glassock

@GlassockJ

2 years

@AgarwalRajivMD RASi + FINERENONE+SGLT2i= little hyperkalemia worries- lots of benefits.

1

11

37

Richard J. Glassock

@GlassockJ

2 years

@worldkidneyday What is the ‘Right” amount of water? When you are thirsty drink.

2

7

35

Richard J. Glassock

@GlassockJ

2 years

@drpriyajohn Oxford MEST-C scores are not used to determine treatment. Presumably, this patient has severe chronic liver disease (possibly with hepato-renal syndrome) and secondary IgA deposition. In this case, the MEST-C score will have no utility in determining prognosis.

1

2

37

Richard J. Glassock

@GlassockJ

4 years

One thing is for sure— SoMe is an ideal place for dissemination of anecdotes, as there is no peer-review. This has both a good and bad side. It can create something out of nothing, especially during the worrisome times we are facing.

2

5

37

Richard J. Glassock

@GlassockJ

3 years

@SethiRenalPath Great pic! Brings home the old notion that AKI in Crescentic GN is a form of intra-Nephronal obstructive uropathy (by occlusion of the junction of Bowman’s space and the nascent proximal tubule of many Nephrons).

0

1

37

Richard J. Glassock

@GlassockJ

4 years

@kidney_boy The more I look at this, the less I like it. diabetes with albuminuria at 500mg /gm and an eGFR of 65ml/min/1.73M2 as “Stage Zero”- not likely. This is 10x worse than a 65 year old with an eGFR of 55ml/min/1.73M2 and albuminuria of 10mg/gm. It is too eGFR centric, IMO

1

2

37

Richard J. Glassock

@GlassockJ

5 years

Those who worship the “golden calf” of Nephrology (Dialysis) may be subject to a rude awakening in the future as the focus shifts to prevention and avoidance of center based RRT. The frequently foretold “epidemic” of diabetes related ESRD is not an assured paradigm as well.

2

3

35

Richard J. Glassock

@GlassockJ

5 years

@hswapnil @Marilina_A_ I was disappointed with the outcome of NephMadness in 2019. The USA Guideline are strongly based on SPRINT-a study of High-CVD risk non-Diabetic hypertensive subjects- but the US Guideline chose to generalize recommendations using a BP threshold that was not part of SPRINT.

2

5

36

Richard J. Glassock

@GlassockJ

2 years

@miriam_khalil13 Do no harm.

2

3

35

Richard J. Glassock

@GlassockJ

3 years

@SethiRenalPath Well done, Sanjeev. We need to stop thinking about MN as a single Disease. Translating a morphologic appearance (a “pattern of injury”) into a disease entity (as we have done with FSGS) gives nothing but problems down the road.

2

3

36

Richard J. Glassock

@GlassockJ

2 years

@LangoteAmit @arvindcanchi @myadla @Filter_work @Nair_Sanj @drmanishasahay @gag_aggarwal @NephRodby @WomenNeph_india This looks more like acquired perforating dermatosis than calciphylaxis.

2

0

35

Richard J. Glassock

@GlassockJ

2 years

@nephronus I believe that Fibrates increase production rate of creatinine, so serum creatinine rises until a new steady state is achieved. Urine creatinine is increased, but GFR and endogenous CCr is unchanged. The rise in SCr (and fall in eGFR ) is not a sign of “nephrotoxicity”.

1

0

35

Richard J. Glassock

@GlassockJ

4 years

@kamkalantar @Pocket If you are normal, adequate hydration can be defined as a lack of thirst.

1

5

35

Richard J. Glassock

@GlassockJ

5 years

JT and SH, I just read your very informative Editorial in CJASN on CKD apps for smartphones and iPADs. What the field needs is a “Good Housekeeping” Seal of Approval provided by ASN- perhaps as a joint venture with Consumer Reports. Thanks for such a well written piece.

3

6

35

Richard J. Glassock

@GlassockJ

2 years

@GenNextMD @hswapnil The “staging “ system (really a categorization of a continuum) was created mainly by epidemiologists, it is not well suited to bedside medicine and the care of individual patients as one of the categorical variables (eGFR) has a rather low precision and modest bias..

3

5

33

Richard J. Glassock

@GlassockJ

3 years

@ISNkidneycare @KIReports @vjha126 The “excess” of stage 3 CKD in the general population is largely due to its “over-diagnosis” in the elderly using the standard eGFR thresholds for diagnosis as well as the use of “one-off” serum creatinine values. Thus, the “CKD Pyramid” is a distorted form of reality, IMO.

4

8

34

Richard J. Glassock

@GlassockJ

5 years

I have no personal animus to “plant based” diets- they likely bring health benefits. I believe that evidence for a beneficial effect on the rate of progression of CKD is weak/inconclusive -more/better RCT are needed to provide convincing evidence for a global recommendation.

0

7

34

Richard J. Glassock

@GlassockJ

4 months

Dr. Cavanaugh. Thanks for your question. In response , I offer the hypothesis that moderate oral doses of methyl prednisolone are equivalent to targeted release Budesonide in terms of efficacy and safety for reducing proteinuria and delaying ESKD in IgAN. Am I wrong?

1

3

33

Richard J. Glassock

@GlassockJ

4 years

@silvishah Back in the “old days” massive doses of IV Penicillin (10,000,000 units per day for weeks) were used in treatment of infective endocarditis- hypokalemia was common- the effect of excretion of a non-reabsorbable anion (penicillin) on the distal Nephron promoting renal K loss.

3

34