iiinova — where your digital self keeps evolving

Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 05/08/2026

Isn’t this just a set up for selection bias by indication? How do you retrospectively “target trial” emulate a contrast CT? Patients who got contrast post AKI could have unmeasurable illness. Patients who didn’t get it were obviously doing ok. @kidneyboy.bsky.social @hswapnil.medsky.social

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 21/07/2026

Any experience with generic budesonide versus Tarpeyo(targeted release budesonide) for IgA nephropathy? All I can find are proteinuria studies and increased risk of systemic side effects. Blue Cross wants patient to fail generic budesonide for 3 months before approving Tarpeyo. #askrenal

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 14/07/2026

Crescentic IgA on biopsy. Blue Cross Blue Shield says patient has to fail ACE inhibitors alone for 3 months before trying Tarpeyo. This will be overturned on appeal but why-oh-why do we do this dance every time? Nephrologists start hating GN clinics because the paperwork burns everyone out

static.klipy.com

Stan Marsh Asks: Why Do We Do This?

ALT: Stan Marsh Asks: Why Do We Do This?

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 05/07/2026

Critical need for control group reform in RCTs. If you are seeking FDA approval by comparing to placebo or a weak control, your drug should be subject to price controls at 1.5x the current Rx. If you want premium pricing, pony up $$$ and do a comparative effectiveness trial against a strong control

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 27/05/2026

LLMs really impress the nephrologists who like to make a diagnosis of hypertension as the most common cause of ESRD. Or propagate the myth of widespread “hypertensive nephrosclerosis”

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 16/05/2026

AI is absolutely amazing at coming up with rhyming hints for scavenger hunts. Remind me again how profitable that business is.

static.klipy.com

Man Thinking Deeply with Math Equations

ALT: Man Thinking Deeply with Math Equations

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 12/05/2026

No one could afford #flozin for years but 3 patients today have told me they are buying shilajit or some BS supplement that costs $200 “to help my kidneys”. The supplement industry brainwashing is ridiculous. Kudos to the affordable dapagliflozin now! I hope @costplusdrugs.com never run out of it.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 14/04/2026

Sparsentan in FSGS: pay us a million dollars over 8 years in drug cost. Your EGFR will be 34 instead of 30!!! Nephrology is becoming the new oncology. Surrogate outcomes and pricey meds galore without real progress. We are winning the war on kidney disease, just as we won the war on cancer.

media.tenor.com

a man in a plaid jacket says " no i don t think so "

ALT: a man in a plaid jacket says " no i don t think so "

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 26/02/2026

Not sure about the conclusion. It’s not a randomized study so only patients with clinical equipoise would have undergone a biopsy. The results just show nephrologists’ pre-test intuitions are quite good.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 15/01/2026

Not the best marketing strategy unfortunately. Nephrologists’ professional growth pathways are not as convoluted as pretzel word-finding exercises.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 07/01/2026

And my conscience says that a drug costing $600,000 a year should be ashamed of doing a trial with only protenuria as an outcome. They should get a 50% price cut just for cutting corners.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 23/12/2025

Not just a huge vulnerability in medical stuff. This should affect every major corporate application of LLMs. The question is why did the stock market not fall with this study?

media.tenor.com

a man in a suit talking on a cell phone with the words yep there 's a bubble below him

ALT: a man in a suit talking on a cell phone with the words yep there 's a bubble below him

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 03/12/2025

What type of fish oil commercially available in the US most closely approximates the PISCES study formulation? Not an expert but I think not every fish oil being sold is equivalent. #askrenal #nephjc #nephsky

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Juan Carlos Q Vélez, MD @juancarlosqvelez.bsky.social · 20/10/2025

And why did finerenone get away with it? Kerendia is being prescribed right and left now because they had the RCT data and FDA approval. But it’s very clear to me that old MRAs r just as protective, just lacked the RCT data for non medical circumstances. An unpopular opinion, but I own it.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 19/10/2025

My initial thoughts about aldosterone synthase inhibitors: why spend $$$$ to achieve what $4 of spironolactone can also achieve? Am I missing something? #askrenal

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jsxover.bsky.social @jsxover.bsky.social · 11/10/2025

IgA is pronounced eye-gee-ay The reason the disease should be called "eye-gee-ay nephropathy" is because IgA is central to the pathogenic mechanism. Moving to eye-gan is moving away from describing the disease by its pathogenic mechanism.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 10/10/2025

Is calling “I-G-A nephropathy” “Eye-GAN” mainstream now? I am really struggling to accept that. #askrenal

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Merriam-Webster @merriam-webster.com · 12/09/2025

‘Booty’ and ‘butt’ are synonyms. ‘Call’ and ‘dial’ are synonyms. But, a ‘booty call’ and a ‘butt dial’ are VERY different things.

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Karandeep(Singh) @kdpsingh.bsky.social · 05/09/2025

Mother: I have twins. Doctor: Oh, so they were born on the same day? Mother: No, they were born with the same propensity score.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 06/06/2025

Time to make a polypill for CKD? Telmisartan+ #flozin + finerinone + statin+ oral semaglutide? Call it Tel-em-fine-at-tide Telemfinatide? At least for countries with affordable pharma price negotiations.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 26/04/2025

Lately, I don’t enjoy @nkf-professionals.bsky.social or @asnkidney.bsky.social meetings as much as @renalphysicians.bsky.social First 2 are about “cool drugs that cost a million and improve 1% of patients by 30%” rather than “How to survive & thrive as a burnt out specialty no one wants to join”

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KatieOverV @katiekwonmd.bsky.social · 19/04/2025

Funny that tool looks familiar… downloaded from the RPA store

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 24/03/2025

“If you have abdominal pain on the right, upper or lower, around belly button or lower, severe, throbbing, in one spot or moving around, go to the ER (not PCP or urgent care)”- HuffPost Next article coming soon: “Crisis: How ER visits drive up healthcare costs” www.huffpost.com/entry/stomac...

huffpost.com

If Your Stomach Pain Feels Like This, It's Time To Go To The ER

Don't dismiss these red flags — they could warrant medical attention.

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Alex Chang, MD @alexchangmd.bsky.social · 02/03/2025

“officials regularly ignore the rankings, leapfrogging over hundreds or even thousands of people when they give out kidneys, livers, lungs and hearts. These organs often go to recipients who are not as sick, have not been waiting nearly as long…” www.nytimes.com/interactive/...

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 28/02/2025

Adult nephrologists, with your hospital administration and state malpractice environment, would you feel comfortable dialyzing a kid coming in with toxic ingestion if asked to? Why/ why not? #askrenal

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Adam Kucharski @adamjkucharski.bsky.social · 23/02/2025

Once upon a time, some villagers came across a large, ornate wooden box in the local woods. On the side of the box was a message: “Whatever money you put in this box will, in future, grow to become 2.5 times larger.” 1/

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Christos Argyropoulos MD, PhD, FASN 🇺🇸 0kale/acc @christosargyrop.bsky.social · 08/02/2025

Interesting thread by James Heather about the indirect rate caps by the #NIH . It is not the first time this comes up e.g. both the Obama and the 1st DJT admin tried to cap them (with fierce discussions on Twitter back in 2017).

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JAMES HEATHERS (@jamesheathers.bsky.social)

I have a piece half-done on the entire world of indirect costs. It's too big an endeavor to finish now, in the middle of the night, when this problem *that was always a live grenade with a…

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 30/01/2025

US nephrologists, while discussing incoming fellow quality with regional faculty, most seem to be disappointed (big picture, everyone has many bright spots). New meds but worries about doc quality. How do you see the future of nephrology in 10 years? Stable/ascendant/declining?Why? #askrenal#nephsky

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 22/01/2025

Things used in nephrology without evidence or despite evidence of futility: Urine eosinophils Urine anion gap Albumin correction for anion gap and calcium Slow correction for mild-moderate hyponatremia Vitamin D for renal bone disease Anything else to add to list? #askrenal

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 17/01/2025

“Even mildly elevated serum phosphate levels of >3.5 or >4.0 mg/dL should receive attention” What do we mean by attention? Identify phos as risk factor when stratifying-maybe. But pretty please don’t let it mean use phos binders to lower phos below 4 in ADPKD

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 16/01/2025

Nephrologists/physicians, what licenses do you need to keep working and what dues do you pay to remain a member? Lets document costs.For me: State license:$360 DEA: $888 Special CME for dea/ state: $550 ABIM: $340 ASN: $475 RPA: $435 1 meeting/ year: $2000 AMA: free (institution) #askrenal #medsky

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 16/01/2025

My extortion notice with the associated gangster threat has arrived.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 07/01/2025

US nephrologists, how are you posting urine sediment pics given CLIA law requiring special microscope handling/regulatory training and retraining? A- What? I wasn’t aware B- I use my lab’s stuff and document regular re-training C- Keep department microscope with CLIA compliant records #askrenal

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Alex Chang, MD @alexchangmd.bsky.social · 03/01/2025

Happy to share our paper in @asnpublications.bsky.social examining COL4A5 X-linked Alport Syndrome in an unselected health system-based population. Phenotypic spectrum of X-linked Alport syndrome is wider than previously known. Risk lower for Gly624Asp variant. 1/ journals.lww.com/jasn/fulltex...

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 31/12/2024

Controversial take: the social worker role in dialysis should be completely revamped. Stop wasting their time on worthless KDQOL data collection and certify them in psychotherapy and CBT instead so dialysis patients have weekly access to therapy sessions. #Nephsky jamanetwork.com/journals/jam...

jamanetwork.com

Pain Coping Skills Training for Patients Receiving Hemodialysis

This randomized clinical trial evaluates the effectiveness of pain coping skills training, a cognitive behavioral intervention, on pain interference among people receiving maintenance hemodialysis.

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 23/12/2024

Suggested 2025 nephrology research resolution: any institution/ investigator asking for new funding for another Vitamin D trial in nephrology should be personally responsible to return the waste of funding dollars if the trial results are similar to the past 149 trials. #StopResearchFundWaste

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 22/12/2024

Everything cool until the end ‘…we need further high-quality vitamin D trials which focus on clinically meaningful outcomes including fractures, BMD, as well as cardiovascular and kidney endpoints.’ Nope. We need a moratorium on vitamin D trials @maximalchange.bsky.social #NephSky

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 22/12/2024

Paraphrasing another candid trainee reason for not choosing nephrology🧵(1/3) “You guys never seem to do anything for the majority of your inpatient consults. Cardio stents/stress tests, hem/onc blasts with fancy genetically determined meds, rheum uses cool meds all the time. GI scopes most of them…

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 12/12/2024

Anyone got a gold standard way to wean advanced CKD patients off baclofen? A lot of nephrologists are just asking people to stop taking it and withdrawal can be life threatening (saw 2 cases and don’t want to see any more) #askrenal

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Gurmukteshwar Singh, MD @drmootravardhak.bsky.social · 25/11/2024

Urgent start PD is a logistical nightmare in most of the US. Lack of nurses, surgeons refusing to take sick people to OR but ok for HD catheter, poor expertise to manage complications, few outpatient trainers when needed. Not sure a reduced risk of peri-catheter bleed will overcome all that.

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