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
2,443 posts
5,223 followers
3,003 following
Regular Contributor
Active Commenter
comment in response to
post
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.
comment in response to
post
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
comment in response to
post
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
comment in response to
post
Yep. Using that more and more - when I can convince insurance companies that it's not 'experimental'
#nephsky #nephjc
comment in response to
post
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
comment in response to
post
The hirsutism and similar side effects?
#NephJC
(I am at a stage where I may not mind some 🤪)
comment in response to
post
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
comment in response to
post
Cc @johngreensbluesky.bsky.social
We will be doing your book for #NephJC book club in August!
comment in response to
post
#NephJC
comment in response to
post
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
comment in response to
post
#NephJC I’m not convinced these are different groups from a pathophysiology standpoint. SDNS and FRNS act the same with response to treatment.
comment in response to
post
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
comment in response to
post
Right?! But we never monitor levels, at least in adults #NephJC
comment in response to
post
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
comment in response to
post
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
comment in response to
post
What are highlights of the @ped-neph.bsky.social that make the GL better?
#NephJC
comment in response to
post
Again, prefer this one...
pubmed.ncbi.nlm.nih.gov/32382828/
#nephsky #nephjc
comment in response to
post
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
comment in response to
post
Over steroid exposure in children is so important! However need longer-term GFR data for the TAC group.
#nephsky #nephjc
comment in response to
post
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
comment in response to
post
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
comment in response to
post
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
comment in response to
post
Welcome to #NephJC Jarcy!
comment in response to
post
Important point, although most non-MCD is not SSNS in kids but rather variable resistance and rarely achieve admission with just steroids. #NephJC
comment in response to
post
In kids?
Maybe they are looking to exclude nonMCD diagnoses?
#NephJC
comment in response to
post
Yay - great to see you here Jos!
#NephJC
comment in response to
post
Hey Marc! Great to see you here
#NephJC