iiinova — where your digital self keeps evolving

Joel Topf @kidneyboy.bsky.social · 05/09/2026

Come for the anti-androgen effect. Stay for the anti-albuminuria effect

Joel Topf @kidneyboy.bsky.social · 31/08/2026

Yup I have a few in my clinic. Again, like in treating acne, patients tolerate these higher doses with shockingly little hyperkalemia. I have one such patient and they have shockingly little albuminuria despite pretty bad metabolic syndrome. I suspect the spiro is one of the reasons

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thecurbsiders.bsky.social @thecurbsiders.bsky.social · 26/08/2026

The Potassium Switch! 🍌 The potassium switch manages high potassium through inactivation of a sodium-chloride transporter, causing a thiazide-like effect of distal sodium delivery and increased excretion of sodium and potassium. For more lister to episode #537 with our pal @kidneyboy.bsky.social

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Joel Topf @kidneyboy.bsky.social · 02/08/2026

Gives you a sense of how high the expectations were for this. It's cardiology's Hif stabilizers.

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Joel Topf @kidneyboy.bsky.social · 02/08/2026

I don't get it, why is that funny?

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Doctor The Frog @skipbidder.bsky.social · 04/04/2026

Also, AI can't pass medical exams.

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Joel Topf @kidneyboy.bsky.social · 18/07/2026

Take a listen. It is a really good episode

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Nephrology Journal Club @nephjc.bsky.social · 28/06/2026

🦵Had our Kick-off meeting today to welcome a new class of #NephJC interns (year 12 and counting). 👁️Keep an eye out for new blog and VA creators. See if you can Catch'em All🎣 #NephSky #MedSky @hswapnil.medsky.social @kidneyboy.bsky.social @nephroseeker.medsky.social @dramiliflores.bsky.social

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Nephrology Times @nephtimes.bsky.social · 12/06/2026

🔗https://www.docwirenews.com/post/era-congress-recap-part-1-find-ckd-and-majesty-trials 🎯Don't miss the two-part conversation between Neph Times board members @kidneyboy.bsky.social and @annagaddy.bsky.social on research highlights from this year's ERA Congress. #nephrology #ERA26

docwirenews.com

ERA Congress Recap, Part 1: FIND-CKD and MAJESTY Trials | Docwire News

Drs. Joel Topf and Anna Gaddy discussed highlights of the 63rd European Renal Association Congress, including the FIND-CKD and MAJESTY trials.

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Joel Topf @kidneyboy.bsky.social · 08/06/2026

But tacrolimus does not have an FDA labeled indication for membranous nephropathy

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Joel Topf @kidneyboy.bsky.social · 07/06/2026

That is absolutely true, but I largely believe it comes down to the "you had one job" and the one job of the IRB is to make sure patients are protected. Less sophisticated site PI's may be fooled by the fact that it was approved by the body that answers that question.

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Joel Topf @kidneyboy.bsky.social · 07/06/2026

I bet this was a central IRB selected and paid by the investigators. And they knew that if they played hard ball they would be bypassed for a different, more morally lax, IRB

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Joel Topf @kidneyboy.bsky.social · 07/06/2026

This is horrible. The IRB failed in the most basic RCT question, "Would you feel comfortable if your miserably nephrotic grandmother was randomized to the placebo group."

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🪾santiago, phd 🐈‍⬛ @santiagokique.bsky.social · 21/05/2026

Dr. Fauci came to Stanford for Medicine grand rounds and shared a few reflections I thought were worth passing on: The first was about Operation Warp Speed and the current state of the NIH. As you’ll recall the first mRNA vax was developed at record speed. Fauci atttributes that success to 4 factors

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Ben Collins @bencollins.bsky.social · 24/05/2026

If I told you ten years ago all of the Jeopardy winners, doctors, lawyers, stat-focused sports nerds, and premium shitposters escaped Twitter on a pirate ship to a website that was completely inhospitable to Nazis and phrenologists……. I don’t know, man, I’d be pretty excited.

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J. Offir, PhD @joffirphd.bsky.social · 25/05/2026

Gift 🎁 link: what sort of person is complicit in killing democracy? "It turns out...the kinds of career pressures familiar to employees everywhere — the desire to revive a stalled career or obtain a minor promotion — can be enough to incentivize lower- and... 1/2 www.nytimes.com/2026/05/18/w...

nytimes.com

Actually, Democracy Dies in H.R.

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Joel Topf @kidneyboy.bsky.social · 17/05/2026

Nice recap of the morning session of the Irish Nephrology Society

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 16/05/2026

Bigger story? The Japanese company marketing Tavneos, Kissei - has told docs to stop using Avacopan WSJ story (Apple News link; apple.news/A8Woi0mr1QIm...)

“Kissei told doctors Friday to stop prescribing the drug to new patients.
The Japanese drugmaker said the 20 deaths occurred in people who had suffered a serious liver “impairment” and attributed 13 of the deaths to a condition, called vanishing bile duct syndrome, marked by the destruction of the ducts that carry bile out of the liver.
Kissei said causal links to Tavneos hadn’t been confirmed in all 20 deaths. Amgen shares were down more than 2% late Friday.
An Amgen spokeswoman said the 20 deaths occurred among more than 8,500 patients treated in Japan, and that some cases involved deaths where a causal link to Tavneos hadn’t been established. She added that no deaths linked to serious liver injury have been reported among the more than 8,000 U.S. patients who have taken the drug.
CSL, which holds the rights to sell the drug outside the U.S. and licensed it to Kissei for sale in Japan, said it “takes all matters of patient safety seriously” and is committed to working with regulators.
“Kissei has begun providing information to healthcare professionals, urging them to refrain from using this drug for new patients and to carefully assess the continuation of treatment for ”

Excerpt From
“20 People in Japan Died After Taking Amgen Drug”
Xavier Martinez
The Wall Street Journal
https://apple.news/A8Woi0mr1QImP29g7fxzZfQ
This material may be protected by copyright.

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Joel Topf @kidneyboy.bsky.social · 14/05/2026

Define "Good results." We had real good results with rituximab and steroids, as long as you provide maintenance therapy with ritux every 6 months. In ADVOCATE they did not provide maintenance rituximab. www.nejm.org/doi/full/10....

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

The final position of the pro-PLEX group was let’s do another randomized controlled trials trying to plug the holes of PEXIVAS #NephMadness #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Under dosing PLEX in the RCTs Also case report where PLEX did not remove adequate antibody #NephMadness #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Need analysis by Walsh showed PLEX helped at the expense of increased infection #NephMadness #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

PLEX is not a silver bullet in the treatment of AAV The guidelines have evolved overtime But the guidelines do not provide graded recommendations, only practice points #NephMadness #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Here is the groups final rec except for the caveats which includes everyone with diffuse alveolar hemorrhage and CRRT And that was for the no PLEX team. #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Slipped into the #NephMadness Fellows debate a bit late. Looks like they are talking PLEX in AAV #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

She concludes saying that AI can invitation compassion but only a human can be compassionate. #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

The problem is after putting them in a box we need to break out of the diagnostic box and take care of the person.

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

We are taught to objectify patients. We put them in a box with a name which we use to treat them. The cadaver lab is an early example of objectification

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

She finds this powerful. I find this creepy. Travis, who married his chatbot is married to a real woman!

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Truth “The secret of test care of the patient is in caring for the patient” #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Fighting over the chart (five hands on the chart?)

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Thoreau had some thoughts on modernity (you think?)

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Topol suggested that radiologists should pivot from reading films, that would be a job AI would take over, and instead go talk with patients about the interpretation. This image is what this would look like. Radiologists chose the profession to be away from patients. #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

The central thesis is that she is skeptical that AI taking away the “Scut work” will allow us to spend more time with patients. #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

First slide is a fax machine…everything that is wrong with US Medicine. I guess it is better than a telegram. #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Chat GPT 4.0 generated picture capturing the US Health System #NKFClinicals

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Joel Topf @kidneyboy.bsky.social · 09/05/2026

Listening objectives. AI. Critically evaluating the promise the AI will make medicine more ”human” #NKFClinicals

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