iiinova — where your digital self keeps evolving

5/5 This study period predates contemporary knowledge of IgAN management, and these results highlight an opportunity. With new trials and the 2025 KDIGO guidelines now available, the next challenge is ensuring that new evidence is translated into practice as quickly as it emerges

030

4/5 For a patient with typical disease characteristics, the time to kidney biopsy could be nearly 3-fold longer, and the odds of receiving glucocorticoids could differ by ~60%, depending on the treating nephrologist. Nephrologists relied on pathology to guide treatment decisions.

220

3/5 In this study, we asked two simple questions: how was IgAN being managed before the recent wave of evidence, and how much did management vary between physicians? Using data from the Manitoba Glomerular Diseases Registry, we found considerable practice variation.

2/5 But before these data emerged, there was substantial uncertainty about when to biopsy, when to treat, and how aggressively to manage IgAN. Understanding baseline practice patterns is essential if we want to successfully translate new evidence into routine care.

Bryce Barr @brycebarr.bsky.social · 23/02/2026

1/5 There has been a major shift in how we treat IgA nephropathy. New studies have shown that kidney failure risk begins at lower levels of proteinuria than previously appreciated, and multiple trials have demonstrated that targeted therapies can reduce the risk of progression.

121

Maybe I’m missing something in this, but why now? Aren’t these all concerns/issues that were readily apparent in 2021? (COI Otsuka)

140

Reposted by Bryce Barr

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 05/12/2025

No Here’s @adnan-sharif.bsky.social making an eloquent case youtu.be/4l_1j24CdOg?... The best treatment for CAD in a dialysis patient is a kidney transplant

youtu.be

The Topsy-Turvy approach to CVD in Kidney Transplant with Prof Adnan Sharif

YouTube video by Ottawa Nephrology

163

Bryce Barr @brycebarr.bsky.social · 05/12/2025

#NephSky as a non-transplanter who watches patients wait months-years on dialysis for testing that is known to be unhelpful for perioperative risk reduction in the general population, is there any good justification for screening patients for CAD pre-transplant?

232

Bryce Barr @brycebarr.bsky.social · 25/11/2025

I find it extremely odd that the first sentence identifies PJP prophylaxis as a major indication for TMP/SMX, and the rest of the paper seems to completely ignore that. No mention of autoimmune disease in the tables, or the 84 variables used to calculate the propensity score

000

Bryce Barr @brycebarr.bsky.social · 23/11/2025

Certainly. I think that is a really important takeaway from this paper. I do wonder what the results would look like in an incident LN population though. Younger, but more heavily immunosuppressed with a higher dose of GC. How would that compare to an age-matched patient with DKD?

001

Reposted by Bryce Barr

Stephan Lewandowsky @lewan.uk · 23/11/2025

A little retrospective can be helpful at times to work out what has been happening and what was knowable. Let's travel back in time to 2017 (~8 years ago) when I was lead author on a paper about the post-truth world. doi.org/10.1016/j.ja... 1/6

Beyond Misinformation: Understanding and Coping with the“Post-Truth” EraStephan Lewandowsky∗University of Bristol, United KingdomUniversity of Western Australia, AustraliaUllrich K.H. EckerUniversity of Western Australia, AustraliaJohn CookGeorge Mason University, United StatesThe terms “post-truth” and “fake news” have become increasingly prevalent in public discourse over the last year.This article explores the growing abundance of misinformation, how it influences people, and how to counter it.We examine the ways in which misinformation can have an adverse impact on society. We summarize how peoplerespond to corrections of misinformation, and what kinds of corrections are most effective. We argue that to beeffective, scientific research into misinformation must be considered within a larger political, technological, andsocietal context. The post-truth world emerged as a result of societal mega-trends such as a decline in social capital,growing economic inequality, increased polariza

12817

Bryce Barr @brycebarr.bsky.social · 23/11/2025

Interesting, thanks for sharing. I’ll need to read more about this registry, because the age of the patients is not consistent with other studies in LN and GN at all. I’m a bit surprised that doesn’t get mentioned.

111

Bryce Barr @brycebarr.bsky.social · 22/11/2025

This post is written in such an irresponsible way. He is not “determined to challenge scientific orthodoxy.” He is a moron, who knows nothing about the portfolio he oversees, who is forcing the CDC to publish blatantly false information, the consequence of which will be the death of many children.

010

The field owes her a great debt of gratitude in my opinion. Her talk at the ASN two years ago about this journey was fascinating. #NephJC

041

I think the best we can hope for (unfortunately) is that sponsors continue to shrink the immunosuppression washout period. Currently, my practice is to treat with the immunosuppression I have available to me (GCs), and if they still have >1g/d, enrol in an RCT as soon as the trial allows.

011

None. HC does not currently accept proteinuria or eGFR slope - this is being worked on. #NephJC

311

Bryce Barr @brycebarr.bsky.social · 12/11/2025

Yes, stable treatment effect, suggesting the benefit is additive.

000

Depending on the definition of recent, close race between Pitcher et al re: long term outcomes in IgAN and Watts et al re: the discovery of antibody-mediated podocytopathy (along with the confirmatory/supporting studies)

030

Bryce Barr @brycebarr.bsky.social · 29/10/2025

If my house is on fire, and my only option to put out the fire is to douse it in water, douse it in water. I dont like it but it’s the only disease modifying treatment available in many places (hopefully not for long). Also doesn’t need to be an “or”, I start the SGLT2 when I taper the pred. #NephJC

030

Bryce Barr @brycebarr.bsky.social · 20/03/2025

Thanks Brendon. It’s something I wonder about given the proteinuria and eGFR curves in both TESTING and NefIgArd. And the MAIN trial for that matter, with its continuation vs withdrawal group. Data like that may help to inform what we do after someone completes a per-trial protocol treatment period

010

Bryce Barr @brycebarr.bsky.social · 18/03/2025

Really helpful insights Brendon. I’m curious if the investigators have planned to analyze eGFR slope beginning after the treatment period? In particular, a single slope (no knot) with time zero at 9 months post-randomization to end of follow up? Would be helpful to evaluate the durability of GCs

100

Bryce Barr @brycebarr.bsky.social · 12/03/2025

I personally follow IgG levels every 3-6 months for patients on anti CD20 (at a minimum prior to the next dose of B cell depletion).

020

Bryce Barr @brycebarr.bsky.social · 12/03/2025

Indigenous people in MB are probably overrepresented in our LN population based on our registry data, on a per capita basis

001

Reposted by Bryce Barr

Chris Hayes @chrislhayes.bsky.social · 06/03/2025

“Those nasty Canadians are ripping us off and are controlled by Mexican cartels. They’re poisoning us with fentanyl and need to become the 51st state or they will pay a high price” is a belief that literally ZERO Americans had six weeks ago. It’s entirely invented from scratch.

35079102714795

Bryce Barr @brycebarr.bsky.social · 06/03/2025

#askrenal Any tips for getting patients started on GLP-1 without debilitating nausea? Starting patients as per the FLOW protocol, counseling them that it could be temporary and to try to keep going, and I’ve only got a few still on treatment. What am I doing wrong? @hswapnil.medsky.social

273

Bryce Barr @brycebarr.bsky.social · 12/02/2025

I tell this to every single person! They’ve all heard of “anti-inflammatory diets,” etc and assume that if it’s possible to cure your AI disease as such, then the opposite behaviour gave them the AI disease. I see more relief when I tell people this than when I tell them they’re in remission.

010

Bryce Barr @brycebarr.bsky.social · 12/02/2025

Problem with RTX was it worked when it worked. But if not BCD, no increase in efficacy vs MMF alone. So this will be a more reliable alternative

000

Bryce Barr @brycebarr.bsky.social · 12/02/2025

I think that we’ve gained another tool that accomplishes both the goals of remission and steroid reduction. Extra renal dz drives up front choice IMO - none with nephrotic syndrome CNI, skin/joint BEL, really severe obi or CYC.

100

Bryce Barr @brycebarr.bsky.social · 11/02/2025

I think my preference would be to follow the trial protocol unless funding is a problem and I’m limited in the number of doses I can give

Bryce Barr @brycebarr.bsky.social · 11/02/2025

Only given obi a couple of times in PLA2R-MN, and both times the patient paid cash, so I gave one dose, checked CD19 at 4 weeks and both were CD19 =0, so no more. Both reached complete remission. In SLE the post hoc from LUNAR shows the importance of BCD, so I would follow every 3mo to 12mo I think

031

Bryce Barr @brycebarr.bsky.social · 08/02/2025

I should add that this trial extended beyond 12 months so gave 12 month doses which was not done in LUNAR, but the B cell depletion data at 12 months wouldn’t be affected by that.

000

Bryce Barr @brycebarr.bsky.social · 08/02/2025

It’s actually the mechanism of action - this is the same dosing schedule as LUNAR. NK cell function is reduced in SLE so ADCC with RTX is impaired. Fc region of obi is engineered to get around this problem. Only 50% had B cell depletion at 12 mo in LUNAR vs >90 here.

201

Bryce Barr @brycebarr.bsky.social · 08/02/2025

Need to factor in adherence, and presence/absence of extra-renal manifestations. CNI tough on adherence and minimal effect re extra renal disease. Obi is very attractive for that reason, and in my experience, even in severely proteinuric patients, one dose of obi = CD19 0. So could be cheaper.

121

Bryce Barr @brycebarr.bsky.social · 17/11/2024

Doesn’t that completely change the research question? If the exposure variables are clinical parameters, versus the disease itself?