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hswapnil.medsky.social
Nephrologist = kidney doctor MD, MPH Professor, University of Ottawa/Ottawa Hospital 🇨🇦 He/Him/His #NephJC co-creator, @FreelyFiltered.bsky.social pod panelist #NephSky https://www.swapnilhiremath.com
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I do the same with any agent. Treat for 2 years then try off. If relapse, then another 2 years. #NephJc I don’t think there’s great data. Just seems a good balance of risk.
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In clinical practice, prefer MMF over Tac as first line for SD/FRNS (mostly to avoid need for lab monitoring). And increasingly rituximab! Discuss all options with parents and if insurance overlords permit, ritux it is #nephjc
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Plus- more detailed (example flowcharts shown). It’s written for both ped neph and pediatricians who may be doing some of the evaluation/ management in many lower resources areas. #nephjc
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Yep. Using that more and more - when I can convince insurance companies that it's not 'experimental' #nephsky #nephjc
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Low risk of tac balanced out by real risk of infection and thrombosis in uncontrolled nephrotic syndrome. People forget that 80-90% of these kids died pre-steroid. #NephJC
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The hirsutism and similar side effects? #NephJC (I am at a stage where I may not mind some 🤪)
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Sorry I missed most of today’s #nephjc. Supervising a biopsy! Interested to learn from the paediatric nephrologists. I have to say I increasingly use rituximab over CNI in FR/SD MCD
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Cc @johngreensbluesky.bsky.social We will be doing your book for #NephJC book club in August!
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#NephJC
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Yeah - Tac seems to be superior to MMF (as dosed here) - longer term toxicity caveats of course Good to see large well designed trials from China! #NephJC
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#NephJC I’m not convinced these are different groups from a pathophysiology standpoint. SDNS and FRNS act the same with response to treatment.
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Not all peds trials. But typical age for childhood NS is 3-12yrs (some might say 3-14 yrs). I.e many, many years ago we would call a 13-14 yo atypical NS and consider biopsy before treating. Now even in a 15 yo without any other atypical features, we might try steroids first #nephjc
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Right?! But we never monitor levels, at least in adults #NephJC
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and the reviewers killed these guys for the low MMF levels. if we are going to care about MMF levels/AUC then we should not award MMF benefits because it does not require therapeutic drug monitoring. #NephJC
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this is definitely a major criticism of this paper. One year is too short to show the potential risks of TAC, even though it beats MMF on many levels short-term. #NephJC
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What are highlights of the @ped-neph.bsky.social that make the GL better? #NephJC
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Again, prefer this one... pubmed.ncbi.nlm.nih.gov/32382828/ #nephsky #nephjc
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I always wonder about our one size fits all MMF dosing Eg we discussed this for transplant a while back www.nephjc.com/news/mmf #NephJC
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Over steroid exposure in children is so important! However need longer-term GFR data for the TAC group. #nephsky #nephjc
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Impaired GFR is more likely to be seen in those with secondary nephrotic syndrome, more likely SRNS, and maybe non minimal change. Standard SSNS should have normal kidney function #nephjc
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That slope looks nasty 😰 Maybe one course of Tac is ok - but would be wary of keeping it for long? What do the pednephs think? #NephJC
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it seems crazy to enroll 17 year olds and 3 year olds in the same trial. Are these age ranges typical of pediatric trials? #NephJC
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Welcome to #NephJC Jarcy!
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Important point, although most non-MCD is not SSNS in kids but rather variable resistance and rarely achieve admission with just steroids. #NephJC
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In kids? Maybe they are looking to exclude nonMCD diagnoses? #NephJC
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Yay - great to see you here Jos! #NephJC
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Hey Marc! Great to see you here #NephJC