Alex Chang, MD
@alexchangmd.bsky.social
Associate professor, clinician-scientist/dad/husband interested in early prevention/treatment of kidney disease tweets=personal views #nephsky
Didn't work bsky.app/profile/rnfl...
David W (aka Flex NP)@rnflex.bsky.social · 5d agoThe hazard ratio is literally null. HR 0.99, 95% CI-0.88-1.11 Quite literally zero benefit At this point I think CVD + inflammation is still alive but requires tweaking and going further upstream. NLRP3/NEK7 probably?
Noninvasive optical coherence tomography biomarker for Alport syndrome, COL4-related focal segmental glomerulosclerosis, and COL4 variant interpretation #nephsky #nephrology www.kidney-international.org/article/S008...
Noninvasive optical coherence tomography biomarker for Alport syndrome, COL4-related focal segmental glomerulosclerosis, and COL4 variant interpretation
Alport syndrome (AS) is a hereditary glomerulopathy often associated with ocular abnormalities, yet structural retinal biomarkers remain underutilized in nephrology. Here, we evaluated the Temporal Th...
kidney-international.org
a young teenager with hypertension, case studies from @nejm.org enough info in table 1 to make a diagnosis! www.nejm.org/doi/full/10....
Another negative early AKI RCT jamanetwork.com/journals/jam... @jaykoyner.bsky.social et al in @jamanetworkopen.com
Early Nephrology Consult and Acute Kidney Injury in Hospitalized Patients
This randomized clinical trial assesses whether a structured early nephrology consultation triggered by a machine-learning acute kidney injury (AKI) risk score in patients at high risk for AKI improve...
jamanetwork.com
As ridiculous as CKD staging is, we have nothing on this thing of utter beauty www.ahajournals.org/doi/10.1161/... We are all stage A HF! Flozinate everyone. GDMT on the drinking water. #medsky #cardiosky /s
German Clinical Practice #Guideline on #Microhematuria in #Children and #Young #Adults: Evaluating Early Detection of Kidney Disease https://doi.org/10.1016/j.ekir.2026.106495 #KIRGuidelines
whoa interesting...Betel nut chewing induces 24(OH)ase expression and decreased serum calcitriol? academic.oup.com/jcem/article...
Vitamin D Metabolism in Peripheral Blood Mononuclear Cells Is Influenced by Chewing “Betel Nut” (Areca catechu) and Vitamin D Status
Abstract. Context: Vitamin D deficiency, common in South Asians, is a risk factor for metabolic syndrome, type 2 diabetes, and ischemic heart disease. Vita
academic.oup.com
Genetic #Screening of Patients With Inherited #FanconiSyndrome #VisualAbstract by Denisse Arellano https://www.kireports.org/article/S2468-0249(26)02808-1/fulltext
Crazy happenings at the #ADA26 Cops show up, snatch papers and shove scientists out www.medpagetoday.com/special-repo...
Video: Police Tussle With Diabetes Experts at ADA Meeting
Researchers told they could no longer attend the annual scientific sessions
medpagetoday.com
Huge effect of mTOR inhibition (sirolimus, everolimus?) in tuberous sclerosis academic.oup.com/ckj/article/... in @ckj-era.bsky.social Not an RCT of course - rare disease and all that! Via @dguerrot.bsky.social on LI #NephSky
Real-world management of tuberous sclerosis complex–associated renal angiomyolipomas: the impact of mTOR inhibitors
ABSTRACTBackground. Renal angiomyolipomas (AMLs) drive substantial morbidity in tuberous sclerosis complex (TSC) through haemorrhage and repeated invasive
academic.oup.com
Important to celebrate the small wins! An outstanding former Geisinger Commonwealth School of Medicine mentee is applying to nephrology!
Interesting paper - Factors Associated With Discussing High Blood Pressure Readings in Clinical Notes. Naturally, nephrology, transplant, internal med are discussing the most (it's part of the job). ID, endocrine, sports medicine and GI > than cardiology? pubmed.ncbi.nlm.nih.gov/39661402/
Impact of Smartphone-Enabled Home Urinary Albumin-to-Creatinine Ratio Testing on Albuminuria Screening and Management bit.ly/4pMQekv (OPEN ACCESS) @alexchangmd.bsky.social
A short Bluetorial on plots of NIH application success rates as a function of percentile. 1/20
a cartoon says hey everybody an old man 's talking while bart simpson looks on
ALT: a cartoon says hey everybody an old man 's talking while bart simpson looks on
media.tenor.com
Clinical course of proteinuria due to cubilin variants: a large multicenter pediatric cohort @ped-neph.bsky.social link.springer.com/article/10.1...
Clinical course of proteinuria due to cubilin variants: a large multicenter pediatric cohort - Pediatric Nephrology
Introduction We aimed to evaluate the clinical and genetic characteristics and clinical course of children with persistent proteinuria associated with CUBN variants. Methods Forty-eight children with ...
link.springer.com
Use of auto BP devices is rec'd by guidelines but many still measure BP manually. In this preprint, we categorize BP device based on terminal digit (manual BP results in even # terminal digits). Manual BP ~6mmHg lower and associated with 1.16x stroke risk vs automated www.medrxiv.org/content/10.6...
Underestimation of Blood Pressure and Stroke Risk by Manual Blood Pressure Measurement https://www.medrxiv.org/content/10.64898/2026.02.24.26346929v1
Interesting POV on new therapies in glomerular diseases in NDT #Free academic.oup.com/ndt/article/... What Jon Barratt calls palliative, others call supportive, these call ‘foundational’. RASi and Flozins ✅evidence for BP is opinion I think? But cost issues are huge, as shown here.
![Figure 1:The four established pillars supporting the diagnosis and management of CKD in glomerulonephritis: kidney histology, optimal blood pressure control, RAS blockade, and SGLT2 inhibition. These form the foundation of current best practice, highlighting the challenge for emerging therapies to integrate into this already optimized framework while still demonstrating additional benefit. The new treatment options for IgA nephropathy include targeting APRIL, BAFF, complement, and CD38, as well as combined AT1 and endothelin receptor inhibitors, and extended-release intestinal budesonide. Illustration created with BioRender and adapted from Li et al., 2025 [49].](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:33h4q6nw674jdcwfxaq2m2nl/bafkreibe6r5nknp6zjzmgwf3t2dgrazhkfvoycuzobvwtczkkz5jubl5uy)
![annual treatment costs of new therapies vary by region, with sparsentan ranging from €56 640 in Germany to $118 800 in the USA [43, 44], slow-release budesonide from €126 655 to $174,00 0 [45], and Iptacopan from €460 510 to $550 377 [45]. Anti-APRIL and anti-BAFF therapies are expected to be in the range of €100 000–150 000 or $100 000–150 000 per patient per year [46]. It is estimated that ~400 000 patients with IgA nephropathy live in the EU and the USA combined, and up to 50% of them may be eligible to receive these new therapies [47, 48].
Given these expenses, the revenue generated by the new specific therapies should be sufficient to support outcome studies conducted on a background of up-to-date therapies, particularly SGLT2 inhibition, as outlined before. At the same time, this is also a call to action for all nephrologists managing patients with glomerular diseases: novel and expensive therapies should not be prescribed uncritically before ensuring that the four fundamental pillars of supportive care are fully in place for at least several months, as demonstrated in the STOP-IgA trial [39].](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:33h4q6nw674jdcwfxaq2m2nl/bafkreiba5o4li72zhbaaipuqlkikslqikj6xmr5pe3dpdxvejfrmcwmzc4)
Glomerular basement membrane (GBM) structural integrity dictates trans-tissu... www.sciencedirect.com/science/arti... Really proud of this Cell Reports paper showing that the potentially pathogenic laminin alpha2 in the Alport GBM comes not from glomerular cells, but from the bloodstream.
Glomerular basement membrane structural integrity dictates trans-tissue deposition of laminin in the kidney
Basement membranes (BMs) are specialized extracellular matrices (ECMs) essential for tissue structure and function. In non-vertebrates, ECM components…
sciencedirect.com
SGLTi question - is it important to consider circumcision status for males? pt mentioned difficulties retracting foreskin due (sugary urine must have some impact) resulting in discontinuation…and happened to notice another pt had a similar problem @askrenal.bsky.social
Excited to share our research letter published today in JAMA on the new Apple Watch Hypertension Notification Feature! jamanetwork.com/journals/jam... 1/n
Smartwatch and Hypertension Notification
This cross-sectional study assesses the potential impact of a smartwatch hypertension notification feature for US adults who have not been diagnosed with hypertension.
jamanetwork.com
#WeekendReads from the Advance articles section Trends in Initial Combination Antihypertensive Therapy in a US Health System 🔗 academic.oup.com/ajh/advance-... 🔒
Trends in Initial Combination Antihypertensive Therapy in a US Health System
AbstractBackground. Initial combination therapy has been recommended for patients with high blood pressure (BP). We evaluated annual trends in initial comb
academic.oup.com
Impact of Smartphone-Enabled Home Urinary Albumin-to-Creatinine Ratio Testing on Albuminuria Screening and Management bit.ly/4pMQekv (OPEN ACCESS) @alexchangmd.bsky.social
I think there could be more clarity in how many labs report results. i.e what threshold should be considered a suppressed renin, positive screen, etc. The variety of different assays/units remains a major source of confusion. Most clinicians won't be aware of Table 5 from the Endo society guideline
For example, my institution's lab historically reported renin/aldo with these reference ranges. Cases of overt PA could be interpreted as normal. But results are now reported with guidance on interpretation with the relevant cutoffs from our lab's assays.
As guidelines rec more Aldo/renin testing in htn, wondering whats labs role to ensure/capture details on relevant factors (timing, Na restriction, meds, KP)? Should labs rec pts test in more standardized conditions, log key details or just do it-clinicians duty to sort out? @askrenal.bsky.social
Excited to share our thoughts on the Apple Watch Hypertension alert! @jordybc.bsky.social @deanpicone.bsky.social @alta-schutte.bsky.social Apple Watch for Hypertension Screening | Hypertension www.ahajournals.org/doi/10.1161/...
Apple Watch for Hypertension Screening | Hypertension
ahajournals.org
Pilot phase PREvention of CardIovascular and DiabEtic kidNey disease in Type 2 Diabetes (PRECIDENTD) trial. Monotherapy vs. dual therapy fill rates were 87% vs. 68% overall (P=0.004) at 10months. Of those filling meds, 22% in monotherapy, 49% in dual therapy d/c'ed pubmed.ncbi.nlm.nih.gov/41456635/
Dual versus monotherapy with SGLT2 inhibitor and GLP-1 receptor agonist:PRECIDENTD pragmatic randomized trial - PubMed
ClinicalTrials.gov, NCT05390892, https://clinicaltrials.gov/study/NCT05390892.
pubmed.ncbi.nlm.nih.gov
I do wonder how much of the effect may be due to initiation of MRA vs higher potassium in itself. #cardiosky #emimcc
NEJM.org@nejm.org · 8mo agoIn patients with cardiovascular disease and an implantable cardioverter–defibrillator, increasing potassium levels to the high-normal range reduced the risk of arrhythmia events, hospitalizations, and death. Full POTCAST trial results and Research Summary: nej.md/4oQtHTN #MedSky
