iiinova — where your digital self keeps evolving

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 15/10/2026

From China, in @jama.com Finally a role for dobutamine? jamanetwork.com/journals/jam... Adding dobutamine to norepi- in patients undergoing surgery for sepsis control periop reduces AKI 🤔 Very specific group to study! #nephsky #emimcc

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 15/10/2026

Annals of unexpected results In @kireports.bsky.social www.kireports.org/article/S246... Podocyte number associates with lower GFR post kidney donation, case control study from Andrew Rule et al

Figure 1 Example of immunohistochemistry staining in the same glomerular section for (A and B) podocyte nuclei (WT1) and then (C and D) overstained for podocyte cytoplasm (GLEPP1). Adjacent section of the same glomerulus stained for (E and F) parietal epithelial cells (PAX8). Left panel is the raw image, and right panel is the segmentation within the annotated yellow boundary for marker-positive nuclei (red outline in B and F) and for marker-positive cytoplasm (red outline in D) using QuPath.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 14/10/2026

Rethinking Guideline Delivery in Nephrology: From Access to Action - Kidney International Reports www.kireports.org/article/S246... See #NephJC and @freelyfiltered.bsky.social contribution to guideline dissemination @kireports.bsky.social from @kidneyboy.bsky.social et al

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 13/10/2026

Interesting mechanistic study; effect of flozins in ADPKD academic.oup.com/ckj/advance-... in @ckj-era.bsky.social Until wwe get the real RCTs from France completed

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 08/10/2026

academic.oup.com/ndt/advance-... In @ndt-era.bsky.social with DAGs showing polygenic score for CKD progression can go awry in a CKD cohort

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 08/10/2026

Sodium Zirconium Cyclosilicate: Unexpected Finding in Management of Hyperkalemia - Kidney International Case Reports www.kicasereports.org/article/S311... Images in Nephrology from KICR June issue

Plain CT showing bowels full of radioopaque material - Lokelma aka sodium zirconium cyclosilicate

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 08/10/2026

Happening today! Atrial fibrillation in dialysis - how can we get the proper definitive RCT done? Ziv Harel at #NephGR in Ottawa

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 08/10/2026

The @isgd.bsky.social document on Centers of excellence for glomerular diseases @kidneyint.bsky.social www.kidney-international.org/article/S008...

Figure 1 Goals and 4 mission areas of Glomerular Disease Centers of Excellence. ISGD, International Society of Glomerular Disease.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 07/10/2026

CGM use associated with maybe a bit lower ACR at 3 years In the era of GDMT this looks so meh @christosargyrop.bsky.social ? jamanetwork.com/journals/jam... in @jamanetworkopen.com

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 02/10/2026

interesting title of the day pubmed.ncbi.nlm.nih.gov/36590677/

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 02/10/2026

And methyluric acid nephropathy in @kireports.bsky.social ! www.sciencedirect.com/science/arti...

$Figure 1. Crystals of 1-methyluric acid in urine and kidney biopsies. (a) Crystalluria, 1-methyluric acid crystals in urine (case 1) were round-shaped with a central maltese cross. Bar = 25 μm. (b) Crystals of 1-methyluric acid were sometimes inside macrophagic cells in urine. Bar = 25 μm. (c,d) Periodic acid–Schiff staining. Intratubular crystallites (case 2) were brown/greenish and refractive in polarized light. Bar = 25 μm. (e) MUC1 immunostaining (red) revealed that crystals were mostly observed within distal tubules and not in the proximal tubules stained in green by lectin Lotus Tetragonolobus. Bar = 25 μm. (f) Scanning electron microscopy evidenced massive and poorly organized crystallites in renal tubules. Bar = 25 μm. (g) Fourier-transform infrared reflectance spectrum evidencing the presence of 1-methyl uric acid in kidney biopsies. (h) Transmittance Fourier-transform infrared spectroscopic analysis reference spectrum obtained from a 1-methyl uric acid stone. (i) Uric acid (dihydrate) transmittance Fourier-transform infrared spectroscopic analysis reference spectrum obtained from a kidney stone, showing differences with 1-methyl uric acid spectrum.$

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 02/10/2026

Ristretto contains ~ 30 mg caffeine (maybe it was a double shot?) Interesting breakdown - but most lead to methyluric acid www.sciencedirect.com/topics/nursi...

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 02/10/2026

10 cups of coffee a day can give you…..a nasty kidney stone www.kidney-international.org/article/S008... in @kidneyint.bsky.social

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 30/09/2026

100% David We talk about 4 pillars for treatment of diabetic kidney disease If we get G-force on time (+/- a flozin) that’s the only pillar you need!

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 30/09/2026

See for USRDS Prevalence in US has flattened adjusted Incidence rate has gone down by ~ 100 PMP in last 20 years And full G-force mobilization has not even happened yet

Top graph showing flat prevalence of dialysis from USRDS 2019 onwards

Bottom graph shows a steady decline in incidence rate of dialysis starting 2006 or so

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 29/09/2026

Happening on Thursday! Danny Gale from @ucl.ac.uk Renal RADAR will be presenting #NephGR

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 25/09/2026

See our discussion from #NephJc with author www.kidneymedicinejournal.org/article/S259... in @kidneymed.bsky.social

Figure 1 (A) Twitter polls from the start of the 2 Tweetchats depicting various clinical scenarios when PLEX could be used. (B) The author’s response to the Twitter polls, clarifying and adding context why the crowd-sourced polling result was wrong. AAV, antineutrophil cytoplasmic antibody-associated vasculitis; DAH, diffuse alveolar hemorrhage; ESKD, end-stage kidney disease; PLEX, plasma exchange; RPGN, rapidly progressive glomerulonephritis; SCr, serum creatinine; SGLT2i, sodium/glucose cotransporter 2 inhibitor.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 24/09/2026

From the department of ‘who could have predicted this?’ ‘Opt-out’ aka presumed consent laws associated with a sharp *decline* in organ donation rates in UK www.bbc.com/news/article...

An "opt-out" donation system was introduced in England in 2020, and presumes consent to donate organs for all adults unless they explicitly remove themselves from the list.
Hurley, who has worked in the field of organ donation for 17 years, said consent rates were at about 67% when the law was changed but dropped to about 57% last year.
She explained: "Because you have the opportunity to opt out, by not opting out we can say that essentially you would be in favour of organ donation and would want to be a donor.
"But what we're seeing is family saying, 'We're not sure if it's what they would have wanted', and actually what we need to see is almost that shift and people going back to opting in on the organ donor register."
Hurley said the NHS was now "calling for one million people who have never registered before to confirm their organ donation decision on the NHS organ donor register".

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 23/09/2026

It's September - so we start #NephGR in Ottawa @uottawamed.bsky.social @ottawahospital.on.ca Tomorrow with Dr Patrick Mark from Glasgow #NephSky

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 23/09/2026

Somewhat related: AKI in women with preeclampsia also has gone up in Canada www.cmaj.ca/content/198/... in @cmaj.ca #nephSky

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 21/09/2026

In @ajkd.bsky.social a few words (Notably created without gen AI) www.ajkd.org/article/S027... A world of kidney beans #NephSky

This digital artwork was created using a digital artwork tool, Procreate, on an iPad without the use of any generative artificial intelligence. It aims to appreciate every patient, nephrology clinician, family member, and caregiver who pours their dedication into making a difference in the lives of those touched by kidney disease. Each of them is represented as a kidney bean.
In this world, you will see a bean pushing through rehabilitation, a bean patiently explaining kidney care to another, a bean receiving dialysis, a bean undergoing a transplant, and countless others, each living their own quiet kidney disease journey.
This artwork took 13 hours and 19 minutes to bring to life, a small reflection of the endless hours those in the world of nephrology give every single day.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 19/09/2026

Following up on BEST FLUIDS - this RCT of ringers versus D5-NS post transplant with surrogate outcomes www.kireports.org/article/S246... in @kireports.bsky.social A bit more confidence that RL may be ~ plasmalyte?

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 19/09/2026

contrast that graph with GFR from longer term follow up

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 19/09/2026

another shot fired in the 'AKI causes subsequent CKD' hypothesis www.bjanaesthesia.org/article/S000... in @bjajournals.bsky.social Longer term data from RELIEF (pubmed.ncbi.nlm.nih.gov/29742967/) showing no increase in CKD despite higher AKI in original trial:

AKI incidence from original RELIEF trial

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 19/09/2026

Interesting analysis - not everyone with primary PTH gets surgery - and this group (surgeons!) want to say there's more 'end organ damage'...incidentally HT in ~ 2/3rds & higher in those who had organ damage versus those who didn't in @jamasurgery.com jamanetwork.com/journals/jam...

Figure 2. Sankey Diagram of the Development of End-Organ Damage and Use of Parathyroidectomy in Primary Hyperparathyroidism

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 19/09/2026

Interesting data point in the initial poll for the CRRT debate at #CSNHomecoming

Who leads CRRT - and seems it’s 44% each for nephrology or ICU in Canada

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 18/09/2026

Dr @lynncornell.bsky.social shows this classic bird’s eye appearance of the kidney biopsy in IgG4 interstitial nephritis Read here www.sciencedirect.com/science/arti... for more in @kireports.bsky.social #CSNHomecoming @csnscn.bsky.social

Birds Eye appearance of kidney - seen in IgG4 TIN

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 18/09/2026

John Gill gives a shoutout to (kidney recipient) John Fluevog Read more about it here ca.fluevog.com/blogs/fluebl... @csnscn.bsky.social #CSNHomecoming

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 18/09/2026

And of course hypertension is a risk factor in GN too A quarter have masked hypertension and almost a half have nocturnal hypertension @csnscn.bsky.social #CSNhomecoming

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 18/09/2026

Suggesting we risk stratify to apply population data to individual patients @csnscn.bsky.social #CSNhomecoming

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 18/09/2026

Mark Canney from @uottawamed.bsky.social shows us the contributors to high CV risk in glomerular diseases at the @csnscn.bsky.social #CSNHomecoming

CV risk contributors - non trad risk factors

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 11/09/2026

Interesting survey on willingness to take fish oil post PISCES academic.oup.com/ckj/article/... IN @ckj-era.bsky.social cc @pisces01.bsky.social

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 26/08/2026

Whoah Hemodialysis since 1975, patient with Alport. academic.oup.com/ckj/article/... in @ckj-era.bsky.social

Timeline of someone who started dialysis in 1975

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 14/08/2026

Look at these brain dead peer review reports That’s all the ‘peer review’ that happened here - and is quite typical for many BMC journals

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 14/08/2026

The next evolution of LLM-d citations The fake hallucinated citations are reducing in submissions I am reviewing But these drive-by citations (or perfomative decorations) are a harder problem - read the full blog: jilltxt.net/misaligned-c... From @jilltxt.bsky.social h/t @deevybee.bsky.social

OK, so the citations here are drive-by citations, performative decorations that make a text look like scholarship without actually doing the work of scholarship. The point of citing sources is to engage in a dialogue with previous researchers, to build on or challenge their work.

But this isn’t just an irrelevant citation. The reason the LLM picks Kitchin 2017 is that it should have cited Kitchin 2023, the book Kitchin wrote specifically about the topic of the whole article.

LLMs don’t pick references logically. They pick them based on statistical pattern recognition, they pick them based on proximity between tokens in the text in the context window (in this case the text Atkinson had already generated at this point of writing the article, or if he pasted the whole article into a tool like Grammarly and asked it to add references, the full text of the article) and tokens in the training data.

You could imagine a chain of connections, though that’s not quite what the multidimensional semantic space of an LLM really looks like. I think this might be a useful way for humans to analyse what’s going on, though.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 12/08/2026

Yeah - huge variation in mortality - not sure I understand why, @christosargyrop.bsky.social ?

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 12/08/2026

If you see incidence *rate* This has been dropping since 2006 So better BP, better DM control, RASi - and now flozination etc?

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 12/08/2026

Also, the deaths on dialysis have not been offset by more people starting HD That has remained flat in very 2020 onwards - partly pre dialysis deaths from COVID etc - partly better care

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 12/08/2026

Also deaths *on* dialysis over 2020-2022

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 11/08/2026

Yup These units are clearly mg/dL not μmol/L 🤦‍♂️

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 08/08/2026

What a waste of NIH money Yes, this was the niche that I thought more vitamin D would make a difference in! /s

Funding/Support: Pharmavite LLC provided the vitamin D3 and placebo capsules for the trial. This article is the result of funding in whole or in part by the National Cancer Institute of the National Institutes of Health (NIH) under award numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology), UG1CA189848, UG1CA189850, UG1CA189953, UG1CA232760, UG1CA233180, UG1CA233290, UG1CA233320, UG1CA233328, U10CA180820 (ECOG-ACRIN), U10CA180868 (NRG Oncology), and R01CA205406 (Dr Ng). Through acceptance of this federal funding, NIH has been given a right to make the author accepted manuscript publicly available in PubMed Central on the official date of publication, as defined by NIH.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 06/08/2026

We love that #NephJc content is reused - that’s the whole purpose of #FOAMEed, learn, teach and pass it forward This was a VA created by Divya Bajpai which was sadly cropped which takes out the logo + creator name That maybe for lack of space - but it’s bad manners - don’t do this! #Medsky

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 03/08/2026

Got my copy for the #NephJC summer book club! www.goodreads.com/book/show/57...

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 31/07/2026

Guidance on nutrition supplementation in dialysis www.kireports.org/article/S246... In @kireports.bsky.social Increasing protein intake once dialysis begins is important!

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 28/07/2026

Both recipients of pig hearts developed acute tubular injury….and remained on CRRT till they passed away What’s going on here? www.kireports.org/article/S246.... In @kireports.bsky.social

Figure 1 Native kidney histopathology at autopsy in two cardiac xenotransplant recipients. (a, b) Light microscopy (hematoxylin and eosin). (a) Patient 1: proximal renal tubules with severe luminal dilatation and epithelial flattening and simplification; segments of denuded tubular basement membrane (arrow). Inset: preserved glomerulus. (b) Patient 2: proximal tubules with luminal dilatation, flattened epithelium, and cytoplasmic vacuolization. Inset: glomerulus with a subtle increase in mesangium (arrowheads). (c, d) Transmission electron microscopy. (c) Patient 1: glomerular capillaries with overall normal glomerular basement membrane and preserved podocyte foot processes without effacement. (d) Patient 2: glomerular capillaries with thickened glomerular basement membrane and increased mesangial matrix (M), consistent with early diabetic glomerulosclerosis; preserved podocyte foot processes without effacement (arrows), despite degenerative changes attributable to post-mortem autolysis. Scale bars: 50 μm (a, b; insets as marked); 6 μm (c); 4 μm (d).

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 27/07/2026

Frailty reversal RCT in CKD www.kireports.org/article/S246... in @kireports.bsky.social I would like to see this replicated

Figure 2 Intervention items. Participants received tailored, multidomain care based on CGA. Nutrition: dietitian-led assessment, diet-record handbook, and an individualized plan with daily energy/protein targets; nutritional supplements (e.g., whey protein or enteral formula) when indicated. Psychology: GDS screening; if positive, psychiatrist/psychologist–guided pharmacotherapy and twice-weekly one-to-one psychotherapy (supportive, psychoeducation, and relaxation). Physical function: specialist-prescribed, home-based program (moderate, progressive; 3× per week; 30 to 45 min; 12 months) targeting strength, balance, and flexibility with warm-up and cool-down. Participants with multiple deficits received concurrent components.

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 27/07/2026

Crazy venous anatomy www.kidney-international.org/article/S008... @kidneyint.bsky.social #NephSky

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 27/07/2026

An RCT from India on supportive care involving social workers and palliative care in dialysis www.kireports.org/article/S246... In @kireports.bsky.social (and from Shankar Prasad, Ottawa Neph alumni!)

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