iiinova — where your digital self keeps evolving

Hemily Zandybell, MD @zandybellnefro.bsky.social · 26/09/2026

Cusco + nephrologists + a microscope = the perfect combo 🏔️🔬🫘 So happy to have spoken at the XIX Peruvian Congress of Nephrology about urinary sediment ✨ Thanks for the casts, the laughs, and the coca tea ☕🌿 #Nephrology #UrinarySediment #Cusco 🇵🇪

020

Hemily Zandybell, MD @zandybellnefro.bsky.social · 16/09/2026

Under polarized light, oval fat bodies in urine can show a striking cross-shaped pattern — the 'Maltese cross.' A classic, low-cost marker of lipiduria, often seen with nephrotic-range proteinuria. #UrinarySediment #urinarymicroscopy

010

Hemily Zandybell, MD @zandybellnefro.bsky.social · 13/09/2026

🎓 This week we had a key Urinary Sediment course at Hospital Almenara, @albertogs.bsky.social Perú 🇵🇪, backed by ISN @theisn.org and the academic quality of @juancarlosqvelez.bsky.social 🙌 🇵🇪🇺🇲 Grateful for all the knowledge shared. #UrinarySediment #Nephrology #ISN

063

Reposted by Hemily Zandybell, MD

Mythri Shankar @nephromythri.bsky.social · 11/08/2026

New open-access review out now 🧬🔬 “Beyond the Bladder: Recognising Glomerular Hematuria and the Role of Genetic Testing in Clinical Practice” A practical guide for clinicians: when to refer, when to test, and how to counsel patients. 📖 doi.org/10.5528/wjtm... #Nephrology #GeneticTesting

022

Hemily Zandybell, MD @zandybellnefro.bsky.social · 09/08/2026

✨ Two great days at ISN's Primer Course in Glomerular Diseases, Montevideo 🇺🇾. Updating on glomerular disease management alongside colleagues from Latin America 🧬. Grateful to ISN @theisn.org and all speakers 🙏 #Nephrology #ISN

041

Hemily Zandybell, MD @zandybellnefro.bsky.social · 13/05/2026

👩🏻 patient, 39 yo, IgA nephropathy, dysmorphic hematuria 🩸 #UrinarySediment #urineMicroscopy

010

Hemily Zandybell, MD @zandybellnefro.bsky.social · 12/05/2026

Are these clustered uric acid crystals? 🫣 pH: 5.0 sG:1020 Male with a history of kidney stones #UrinarySediment

001

Hemily Zandybell, MD @zandybellnefro.bsky.social · 01/05/2026

Yes, it was a difficult case; the patient did not survive and needed a liver transplant. 🥺

000

Hemily Zandybell, MD @zandybellnefro.bsky.social · 01/05/2026

Yes, indeed, the patient was young (33 yo), with esophageal varices and confirmed cirrhosis of alcoholic etiology.

100

Hemily Zandybell, MD @zandybellnefro.bsky.social · 01/05/2026

The patient was admitted with suspected septic shock due to cholangitis, severe hyperbilirubinemia T. bili ~50 mg/dL, AKI Cr ~7 mg/dL, thrombocytopenia (18k), low ADAMTS13 (~9.5%), and Na 135. Bile cast nephropathy was strongly suspected as a major contributor to AKI - multiorgan failure 🤓

110

Hemily Zandybell, MD @zandybellnefro.bsky.social · 30/04/2026

Bilirubin-stained renal tubular epithelial cell cast. Patient with AKI and cirrhosis. #UrinarySediment #urineMicroscopy

160

Hemily Zandybell, MD @zandybellnefro.bsky.social · 11/03/2026

2. Amorphous urates may be found in the urine of a normal subject, but they can also be found in the same pathological conditions associated with uric acid crystalluria like in our case 🤗. Sometimes they can be confused with cocci. G.B. Fogazzi, The Urinary Sediment

010

Hemily Zandybell, MD @zandybellnefro.bsky.social · 11/03/2026

solving the case 🕵️‍♀️: 1. After centrifugation, the pink sediment, also known in the literature as Sedimentum lateritium (pink to reddish colour), is related to the presence of amorphous urate crystals. G.B. Fogazzi, The Urinary Sediment

011

Hemily Zandybell, MD @zandybellnefro.bsky.social · 10/03/2026

I requested a urine sediment analysis because of elevated serum uric acid… . . …and received this sample. 👀 Can you guess what we found under the microscope? 🔬 #UrinarySediment

6103

Reposted by Hemily Zandybell, MD

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 05/03/2026

Finally, FINEONE shows Finerenone reduces albuminuria in T1DM www.nejm.org/doi/full/10.... @nejm.org #NephSKy

figure of albuminuria reduction with finerenone

13113

Reposted by Hemily Zandybell, MD

Edgar V. Lerma 🇵🇭 @edgarvlermamd.medsky.network · 01/03/2026

It’s March once again … #Nephmadness has begun #Nephpearls #NephSky 👉🏼 ajkdblog.org 👉🏼 If you don’t know what it’s about, then it’s time to checkout this 📺 m.youtube.com/watch?v=tZUR...

073

Hemily Zandybell, MD @zandybellnefro.bsky.social · 31/01/2026

Female, 40 yo, LES class IV, cr 3.11 (previous 0.8), hematuria, proteinuria. U-Sed: RBC cast, presence of leukocytes (glitter cells?) #Urinarysediment #urineMicroscopy

173

Hemily Zandybell, MD @zandybellnefro.bsky.social · 14/01/2026

First case of the Year 🫶 Male, 50 years old, recently started dialysis, persistent hematuria? Ph 8.0 sg: 1005 hb + 💦 Urinary sediment: leukocytes, some macrophages, and triple phosphate crystals. No RBC Urine culture pending #UrinarySediment #urineMicroscopy

174

Hemily Zandybell, MD @zandybellnefro.bsky.social · 31/12/2025

Woman, 71 yo, allopurinol user, U-Sed: Uric acid crystals. *First time I've seen crystals; How beautiful these crystals are! 😍 can't imagine how excited I am. Maybe only a few will understand 🤭 Happy New Year 2026! May there be more urinary sediments to explore #urinarysediment #urinarymicroscopy

1114

Reposted by Hemily Zandybell, MD

ISNkidneycare @theisn.org · 18/11/2025

🌍 From Tajikistan to Peru, Rwanda, India, the Maldives, and Pakistan. ISN Educational Ambassadors are helping close gaps in kidney care worldwide. These collaborations show what’s possible when global experts and local clinicians work together to advance kidney health. 🔗 lite.spr.ly/6...

032

Hemily Zandybell, MD @zandybellnefro.bsky.social · 19/12/2025

Woman 👩, 67 yo, No medical history, Cr ↗️ 1.4 -> 2.8 -> 3.5, oliguria, ESR 124. HTLV1 (+) ANCA (-) C3 and C4 normal, Prot 20g/24h U-sed: glomerular hematuria (10% acanthocytes) + bacteriuria.

020

Hemily Zandybell, MD @zandybellnefro.bsky.social · 14/12/2025

Christmas Urinary Microscopy 🎄🔬🫶

010

Hemily Zandybell, MD @zandybellnefro.bsky.social · 14/11/2025

Another day here! at the Urinary Sediment Unit, we continue learning 😎 #UrinarySediment

000

Hemily Zandybell, MD @zandybellnefro.bsky.social · 10/11/2025

I'm delighted to have attended and participated in one of the best international conferences 🇺🇲. See you next year in Denver. Let's continue to advance nephrology! @asnkidney.bsky.social @lluncornefro.bsky.social #kidneywk

040

Hemily Zandybell, MD @zandybellnefro.bsky.social · 06/11/2025

Day 1, #kidneywk 25, We attended the poster presentation, which focused on an important topic: Reducing gaps and strengthening training in urinary sediment analysis. We were joined by someone passionate about U-sed. @juancarlosqvelez.bsky.social , @roxnonna23.bsky.social .

0102

Reposted by Hemily Zandybell, MD

Juan Carlos Q Vélez, MD @juancarlosqvelez.bsky.social · 23/10/2025

Clinic visit, pt w/type 2 diabetes + nephrotic range proteinuria. Persistent hematuria noted (normal cysto 3 mo ago) not c/w diabetic nephropathy. #UrinarySediment 🔬is performed: numerous acanthocytes and a few WBC casts. Serum IgA elevated. Normal C3/C4. Other tests pending. Kidney biopsy planned

1185

Hemily Zandybell, MD @zandybellnefro.bsky.social · 23/10/2025

We are waiting for serological and immunological results, proteinuria still pending, I will share them shortly to complete the case. 🫡

010

Hemily Zandybell, MD @zandybellnefro.bsky.social · 23/10/2025

In this picture, we were unsure if it was a red blood cell cast or a red blood cell cluster due to its shape. What do you think? #UrinarySediment #Urinemicroscopy

400

Hemily Zandybell, MD @zandybellnefro.bsky.social · 23/10/2025

Presence of casts: - Waxy Cast with Erythrocytes (SM stain) #urinarySediment #uSed

200

Hemily Zandybell, MD @zandybellnefro.bsky.social · 23/10/2025

Presence of casts: - Mixed CASTS with erythrocytes

100

Hemily Zandybell, MD @zandybellnefro.bsky.social · 23/10/2025

We found: Hematuria - Red circle: Acanthocytes (4%) - Yellow circle: isomorphic (70%)

173

Hemily Zandybell, MD @zandybellnefro.bsky.social · 23/10/2025

Urine Test Physical-chemical examination: pH 6.0 / SG 1010 / Albumin + / Hemoglobin ++ / Glucose - / Leukocytes + / Nitrites -

100

Hemily Zandybell, MD @zandybellnefro.bsky.social · 23/10/2025

U-Sed Case 👨‍⚕️ 46M with uveitis + acute kidney injury (Cr 0.7 → 4.4 mg/dL) 💬 Symptoms: cough, dyspnea, vomiting, 10-kg weight loss 🧪 Urinalysis: pathologic 🩻 Kidneys: normal size 💭 Could this uveitis + AKI pattern suggest a systemic autoimmune process?

261

Reposted by Hemily Zandybell, MD

Nephrology Journal Club @nephjc.bsky.social · 21/09/2025

5/10 A figure paints 🖼️ a 1000 words! Here’s the infographic: Top 10 nephrology takeaways on HTN prevention & management. From albuminuria to renal denervation it’s all here: VA by @sejalplakhani.bsky.social:thanks for the visual clarity

111

Hemily Zandybell, MD @zandybellnefro.bsky.social · 22/09/2025

Granular Cast in the right picture seen by polarized light #UrinarySediment #UrineMicroscopy

020

Hemily Zandybell, MD @zandybellnefro.bsky.social · 22/09/2025

Coarsely granular, Fatty or RTEC cast? (phase contrast, X400) #UrinarySediment #UrineMicroscopy

110

Hemily Zandybell, MD @zandybellnefro.bsky.social · 22/09/2025

👩🏻 48-year-old woman 📌 History: membranous nephropathy, hypothyroidism, morbid obesity 📈 Admitted for: Massive proteinuria: 10 g/24 h 🧪 Creatinine: 1.4 mg/dL 🟡 Automated urine: no red blood cells We performed urinary sediment and found the following:

241

Hemily Zandybell, MD @zandybellnefro.bsky.social · 19/09/2025

Excellent 👏. Greetings from Peru 🇵🇪. In my department, we're also implementing urinary sediment analysis interpreted by a nephrologist. We're in training.

010

Hemily Zandybell, MD @zandybellnefro.bsky.social · 19/09/2025

🟡 U-Sed: Leukocytes 0-3, red blood cells 0, no specific casts, presence of transitional cells

010

Hemily Zandybell, MD @zandybellnefro.bsky.social · 19/09/2025

👩🏻 75-year-old woman - History of epilepsy 📈 Creatinine: 2.36 → 7.3 mg/dL in 9 days 🧪 Positive MPO ANCA (61.06)

131