Podcasts about fsgs

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Play Episode Listen Later May 10, 2023 20:25

Steve Glover, Co-founder and CEO of ZyVersa Therapeutics, focuses on rare kidney diseases and diseases with an inflammation component. Inflammasomes, the first response in the innate immune system, create an inflammation cascade. The ZyVersa approach targets multiple inflammasomes to address diseases caused by the malfunction of this response. Steve explains, "Inflammation drives a lot of different diseases. And as we get into this a little bit more today, it's everything from kidney disease such as rare diseases such as FSGS and Alport syndrome and diabetic kidney disease all have an inflammation component. And in addition to that, when you look at diseases like Alzheimer's or MS, or Parkinson's, they're inflammation driven as well. So there is a connection between the two disease classes." "I've been in the industry a long time, and every so often the industry finds a new interesting discovery, and inflammasomes are clearly one of those new discoveries. In fact, one of the things I talk about quite a bit is that ten years ago, there were about two or so publications that were available on inflammasomes. Now there are over 20,000 publications available on inflammasomes. And this whole concept of inflammation driving certain diseases has become an area of an immense amount of research and development of products that can inhibit the inflammation you don't want in the human body." "When inflammasomes go into overdrive and are left uninhibited, they can cause a lot of damage to organs and cells in the body. And so, for example, they drive a lot of different diseases, everything from cancers to diseases such as Parkinson's and Alzheimer's disease, and a whole host of CNS diseases, as well as non-CNS diseases, that are driven by this inflammasome activation. So it's really important to find a way to inhibit those cytokines by inhibiting the inflammasome." #ZyVersa $ZVSA #RareDisease #InflammatoryDiseases #KidneyDisease #RenalDisease #FSGS #FocalSegmentalGlomerulosclerosis #AlportSyndrome #DiabeticKidneyDisease #Inflammasomes ZyVersa.com Download the transcript here

Therapies for Renal and Inflammatory Diseases Focus on Inflammasomes with Steve Glover ZyVersa Therapeutics TRANSCRIPT

ceo ms disease alzheimer's disease parkinson inflammation glover therapies cns therapeutics inflammatory renal fsgs alport

Play Episode Listen Later May 10, 2023

Steve Glover, Co-founder and CEO of ZyVersa Therapeutics, focuses on rare kidney diseases and diseases with an inflammation component. Inflammasomes, the first response in the innate immune system, create an inflammation cascade. The ZyVersa approach targets multiple inflammasomes to address diseases caused by the malfunction of this response. Steve explains, "Inflammation drives a lot of different diseases. And as we get into this a little bit more today, it's everything from kidney disease such as rare diseases such as FSGS and Alport syndrome and diabetic kidney disease all have an inflammation component. And in addition to that, when you look at diseases like Alzheimer's or MS, or Parkinson's, they're inflammation driven as well. So there is a connection between the two disease classes." "I've been in the industry a long time, and every so often the industry finds a new interesting discovery, and inflammasomes are clearly one of those new discoveries. In fact, one of the things I talk about quite a bit is that ten years ago, there were about two or so publications that were available on inflammasomes. Now there are over 20,000 publications available on inflammasomes. And this whole concept of inflammation driving certain diseases has become an area of an immense amount of research and development of products that can inhibit the inflammation you don't want in the human body." "When inflammasomes go into overdrive and are left uninhibited, they can cause a lot of damage to organs and cells in the body. And so, for example, they drive a lot of different diseases, everything from cancers to diseases such as Parkinson's and Alzheimer's disease, and a whole host of CNS diseases, as well as non-CNS diseases, that are driven by this inflammasome activation. So it's really important to find a way to inhibit those cytokines by inhibiting the inflammasome." #ZyVersa $ZVSA #RareDisease #InflammatoryDiseases #KidneyDisease #RenalDisease #FSGS #FocalSegmentalGlomerulosclerosis #AlportSyndrome #DiabeticKidneyDisease #Inflammasomes ZyVersa.com Listen to the podcast here

Innovation and Developments in Treating Rare Kidney Disease with Dr. Jula Inrig Travere Therapeutics TRANSCRIPT

Play Episode Listen Later Jan 27, 2023

Dr. Jula Inrig is the Chief Medical Officer of Travere Therapeutics and is eager to find innovative treatments for rare kidney diseases, which can be challenging to diagnose and have limited therapeutic options. In clinical trials, their lead candidate, sparsentan, reduces proteinuria significantly in patients with IgA Nephropathy and focal segmental glomerulosclerosis (FSGS). Travere is working with the U.S. Preventive Task Force to encourage earlier diagnosis and screening for these often silent diseases. Jula explains, "We've mapped out a path to get therapies approved for trying to avoid really what is one of the most detrimental complications of kidney disease, which is kidney failure, where you essentially wind up on dialysis. This is a treatment option where patients need to go into a clinic and be hooked up to a machine which cleans their blood three times a week. Or the other option is transplantation. One of the things that we have worked on is a molecule called sparsentan to try and avoid kidney failure." "Sparsentan is an investigational product candidate. It is a single molecule that doesn't suppress the immune system, which I think for a lot of our patients that's very important. It blocks two hormones that are in the path of causing damage within the kidney. What we have found with sparsentan is it reduces the pressure within the kidney, and it causes some remodeling within the kidney that reduces leakage of protein. When you leak protein within your kidney, that causes the kidney to then not clear toxins and then ultimately to progress faster causing kidney failure." @TravereRare #TravereTherapeutics #RareDiseases #RareKidneyDisease #KidneyDisease #EarlyDiagnosis Travere.com Listen to the podcast here

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Innovation and Developments in Treating Rare Kidney Disease with Dr. Jula Inrig Travere Therapeutics

Play Episode Listen Later Jan 27, 2023 16:21

Dr. Jula Inrig is the Chief Medical Officer of Travere Therapeutics and is eager to find innovative treatments for rare kidney diseases, which can be challenging to diagnose and have limited therapeutic options. In clinical trials, their lead candidate, sparsentan, reduces proteinuria significantly in patients with IgA Nephropathy and focal segmental glomerulosclerosis (FSGS). Travere is working with the U.S. Preventive Task Force to encourage earlier diagnosis and screening for these often silent diseases. Jula explains, "We've mapped out a path to get therapies approved for trying to avoid really what is one of the most detrimental complications of kidney disease, which is kidney failure, where you essentially wind up on dialysis. This is a treatment option where patients need to go into a clinic and be hooked up to a machine which cleans their blood three times a week. Or the other option is transplantation. One of the things that we have worked on is a molecule called sparsentan to try and avoid kidney failure." "Sparsentan is an investigational product candidate. It is a single molecule that doesn't suppress the immune system, which I think for a lot of our patients that's very important. It blocks two hormones that are in the path of causing damage within the kidney. What we have found with sparsentan is it reduces the pressure within the kidney, and it causes some remodeling within the kidney that reduces leakage of protein. When you leak protein within your kidney, that causes the kidney to then not clear toxins and then ultimately to progress faster causing kidney failure." @TravereRare #TravereTherapeutics #RareDiseases #RareKidneyDisease #KidneyDisease Travere.com Download the transcript here

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FSGS: KDIGO 2021 guideline | With Dr Richard Glassock

Play Episode Listen Later Dec 5, 2022 14:39

Description: In 2021, a work group of international experts published an update to the 2012 iteration of this guideline. To do so they reviewed the latest evidence through a systematic literature review, with the aim of providing a useful resource for clinicians caring for individuals with glomerular disease through actionable recommendations. In this episode we speak to Dr Richard Glassock, member of the work group, to hear his insights on the key takeaways from the guideline, and what has changed in this iteration. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. Reference: KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100(4S):S1–S276. Disclosures: Dr Richard Glassock declares the following: Stock Ownership - Reata Pharmaceuticals Speakers Bureau - Aurinia Advisory Board - Alexion, Bio-Cryst, Novartis, Otsuka, RenaSight, Travere, Vertex Consultant - Alexion, Arrowhead, Aurinia, Bio-Cryst, Calliditas, Chinook, Equillium, Horizon Pharma, Ionis, Midornid, Nephro-Sys, Omeros, River3Renal, Therini Bio, Travere, Vera Pharmaceuticals Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships within 24 months (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any ineligible companies. All relevant financial relationships have been mitigated prior to this activity. The content for this series was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors. This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis. Discussion of Off-Label, Investigational or Experimental Drug Use: Corticosteroids are mentioned in the context of the treatment of FSGS. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

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Precision Therapies to Preserve Kidney Function with Dr. Charlotte Jones-Burton Chinook Therapeutics

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Play Episode Listen Later Dec 2, 2022 20:03

Dr. Charlotte Jones-Burton is the Senior Vice President of Product Development and Strategy at Chinook Therapeutics, which is on a mission to change the course of kidney care by discovering and developing precision therapies to maintain kidney function in people who have rare, severe chronic kidney diseases. Charlotte explains, "Our lead clinical program is atrasentan, a highly potent and selective endothelin receptor inhibitor. We believe that it's going to be a best-in-class molecule that's going to target the endothelin pathway. And the condition for which we are developing it is IgA nephropathy. Now, IgA nephropathy is an autoimmune disease that attacks the kidneys, and it affects how our blood is filtered in the small blood vessels of the kidneys that I spoke about. And what happens with IgA nephropathy is that immune complexes can deposit in the kidney and really damage those filtering units inside the kidneys. And when this happens, individuals can have symptoms such as protein spilling into their kidneys. And we know that proteinuria, as we call that, is a strong risk factor for those who will then develop end-stage kidney disease, which means that they may need dialysis or a kidney transplantation to survive." "Now, we know that there are few treatments that are available, and that's why it's really important for patients to also ask the question if there are any clinical trials. And we at Chinook Therapeutics are enrolling patients into clinical trials who have IgA nephropathy. We also are enrolling patients into our AFFINITY clinical trial if they have FSGS, which is also a type of kidney disease, Alport syndrome, or diabetic kidney disease." #ChinookTherapeutics #KidneyDisease #ChronicKidneyDisease #Atrasentan #BIO1301 #PrecisionMedicine #Nephrology #ClinicalTrials #IGAN #RareDisease chinooktx.com Download the transcript here

Precision Therapies to Preserve Kidney Function with Dr. Charlotte Jones-Burton Chinook Therapeutics TRANSCRIPT

strategy senior vice president function burton preserve precision product development kidney therapies therapeutics affinity iga chinook kidney function charlotte jones fsgs alport

Play Episode Listen Later Dec 2, 2022

Dr. Charlotte Jones-Burton is the Senior Vice President of Product Development and Strategy at Chinook Therapeutics, which is on a mission to change the course of kidney care by discovering and developing precision therapies to maintain kidney function in people who have rare, severe chronic kidney diseases. Charlotte explains, "Our lead clinical program is atrasentan, a highly potent and selective endothelin receptor inhibitor. We believe that it's going to be a best-in-class molecule that's going to target the endothelin pathway. And the condition for which we are developing it is IgA nephropathy. Now, IgA nephropathy is an autoimmune disease that attacks the kidneys, and it affects how our blood is filtered in the small blood vessels of the kidneys that I spoke about. And what happens with IgA nephropathy is that immune complexes can deposit in the kidney and really damage those filtering units inside the kidneys. And when this happens, individuals can have symptoms such as protein spilling into their kidneys. And we know that proteinuria, as we call that, is a strong risk factor for those who will then develop end-stage kidney disease, which means that they may need dialysis or a kidney transplantation to survive." "Now, we know that there are few treatments that are available, and that's why it's really important for patients to also ask the question if there are any clinical trials. And we at Chinook Therapeutics are enrolling patients into clinical trials who have IgA nephropathy. We also are enrolling patients into our AFFINITY clinical trial if they have FSGS, which is also a type of kidney disease, Alport syndrome, or diabetic kidney disease." #ChinookTherapeutics #KidneyDisease #ChronicKidneyDisease #Atrasentan #BIO1301 #PrecisionMedicine #Nephrology #ClinicalTrials #IGAN #RareDisease chinooktx.com Listen to the podcast here

Targeting Genetic Kidney Disease

Targeting the Toughest Diseases

Play Episode Listen Later Nov 7, 2022 16:54

NBA great Alonzo Mourning returned home from the Sydney Olympics after winning the gold medal feeling ill. He surprisingly was diagnosed shortly after with kidney disease. Scientists have discovered his type of kidney disease is linked to having genetic variants of the APOL1 gene – ones that 13% of people with African ancestry carry. Dr. Ogo Egbuna leads clinical development for the team researching APOL1-mediated kidney disease at Vertex where they're investigating a small molecule therapy to target its underlying cause.Produced by Bloomberg Media Studios and Vertex Pharmaceuticals. Featured guests:Alonzo Mourning is a retired NBA player, the Vice President, Player Programs for the Miami Heat, an advocate for kidney disease research, and a beneficiary of a kidney transplant.David Friedman is an Associate Professor of Medicine, Harvard Medical School and a Principal Investigator and Nephrologist at Beth Israel Deaconess Medical Center. He's researched and consulted for Vertex Pharmaceuticals.Janice Lea is a Professor of Medicine and Clinical Director of Nephrology at Emory University School of Medicine.Ogo Egbuna is Vice President, Clinical Development at Vertex Pharmaceuticals Read more about Vertex's approach to targeting kidney disease.Produced by Bloomberg Media Studios and Vertex Pharmaceuticals.

FSGS: Current and future therapies | With Dr. Kirk Campbell

Play Episode Listen Later Oct 20, 2022 13:18

Historically, treatment options for focal segmental glomerulosclerosis (FSGS) have been limited to high-dose corticosteroids or calcineurin inhibitors in those ineligible or intolerant to steroids. However, an increase in clinical trial activity in the field of kidney disease may carry hope for novel therapeutic options for FSGS. This is illustrated by the recent approval of dapagliflozin for chronic kidney disease. In this episode, Dr. Kirk Campbell offers his expert opinion into the potential clinical implications of current and investigational therapies, both now and in the future. Learning objective After listening to this podcast series, learners will be able to recall the potential clinical implications of current and investigational therapies for FSGS. References available here Disclosures Dr. Kirk Campbell declares the following financial relationships from the past 24 months: Consultant - ANI, Calliditas, Chinook, Travere Research/grant support - Vertex Liberum IME staff, ACHL staff, and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. The content for this series was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors. This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis. This CME/CE activity might describe the off-label, investigational, or experimental use of medications and/or devices that may exceed their FDA-approved labelling. Physicians should consult the current manufacturers' prescribing information for these products. ACHL requires its speakers to disclose that a product is not labelled for the use under discussion. Funding: This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Eli Lilly has had no influence on the content of this education.

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Indu Sanka | The Jeff Crilley Show

The Jeff Crilley Show

Play Episode Listen Later Aug 22, 2022 16:44

Next on the Jeff Crilley Show, you're going to meet one of the most successful entrepreneurs in the DFW area. She was recently named one of DBJ's 40 Under 40. In this episode Jeff sits down with Indu Sanka, MBA, CEO of First Signs Graphic Solutions (FSGS). For over 11 years, FSGS has been a leading manufacturer of large format graphics and custom business signs for DFW's growing commercial real estate and apartment housing industry. Visit FSGS' website: https://www.fsgsgraphics.com/

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FSGS: Classification and risk prediction | With Prof. An De Vriese

Ridgeview Podcast: CME Series

Play Episode Listen Later Jun 9, 2022 19:08

While FSGS was once thought to be a single disease entity, it is now understood to be a pattern of injury caused by diverse mechanisms, but classifying FSGS accurately can be challenging. In this episode, we provide an overview of these classifications and risk factors that can help stratify disease progression risk and assist with determining management approaches. To help understand how we can most effectively and accurately classify FSGS, we are joined by Professor An De Vriese, who is head of the Division of Nephrology and Infectious Disease at the AZ Sint-Jan hospital in Bruges, Belgium. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: 1. De Vriese AS et al. Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach. J Am Soc Nephrol 2018;29(3):759-774. 2. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100(4S):S1–S276. 3. Jacobs-Cachá C et al. Challenges in primary focal segmental glomerulosclerosis diagnosis: from the diagnostic algorithm to novel biomarkers. Clin Kidney J 2020;14(2):482-491. 4. Friedman DJ & Pollak MR. APOL1 nephropathy: From genetics to clinical applications. CJASN, 2021;16(2):294-303. 5. Zee J et al. APOL1 genotype-associated morphologic changes among patients with focal segmental glomerulosclerosis. Pediatric Nephrology. 2021;36(9):2747-2757. 6. Shabaka A et al. Focal segmental glomerulosclerosis: State-of-the-art and clinical perspective. Nephron 2020;144(9):413-427. Disclosures: Prof. An De Vriese has no disclosures to announce. Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

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Two Truths and a Lie: Flozinator Edition

Tales from the Tubules

Play Episode Listen Later May 30, 2022 19:51

CastSusan ThanabalasingamDana LarsenMythri ShankarSandy SureshReferencesNeal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. New England Journal of Medicine. 2017 Aug 17;377(7):644–57.Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. New England Journal of Medicine. 2019 Jun 13;380(24):2295–306.Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine. 2020 Oct 8;383(15):1436–46.Joshi SS, Singh T, Newby DE, Singh J. Sodium-glucose co-transporter 2 inhibitor therapy: mechanisms of action in heart failure. Heart. 2021 Jul 1;107(13):1032–8.Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. New England Journal of Medicine. 2015 Nov 26;373(22):2117–28.ScriptContributors: Susan Thalabalasingam, Mythri Shankar, Dana Larsen, Sandhya SureshHost (Susan):Hey everyone! Welcome to our episode of 2 truths and a lie, an NSMC podcast.Let's go over the ground rules.One at a time each member of our elite education panel will state two truths and one lie about Nephrology.This episode will focus specifically on SGLT2 inhibitors. The other panelist will then discuss which statement they think is The Lie.Our presenter will then educate us all on which statement is incorrect and why.So let's warm up our lie detectors.Let's meet our four players for today.I'm your host Susan Thanabalasingam and I'm a first year internal medicine resident at Queen's University in Kingston, Ontario, Canada. I'm really excited to be your host today and to have an amazing discussion with these wonderful women today! Our second panelist is Dr. Mythri Shankar from India. Hi Dr. Mythri, can you please introduce yourself?Mythri: Hello everyone. I am Dr. Mythri Shankar, Assistant Professor in Nephrology from Institute of Nephro-urology, Bengaluru, India.I am also the Associate Program Director of the NSMC. Glad to be here and I have no conflicts of interest to declare.Our third Panelist Dr. Dana Larsen from the United States of America! Hi Dr. Larsen, can you please introduce yourself? Dana: Hi all! I am Dana Larsen, a second year nephrology fellow at University of California, San Francisco and so grateful to get to be on this podcast with this great group today. I have no conflicts of interest in today's topics. Our fourth Panelist is Dr. Sandhya Suresh from India. Hi Dr. Suresh, can you please introduce yourself?Sandhya: Hi to all my fellow members of the 4th Pod, the Distal convoluted Pod and also… Hi to everyone listening to this podcast. I am Dr. Sandhya Suresh and I'm an early career nephrologist working in a medical college in Southern India. My only declaration here is that I am a flozinator who is continually amazed by everything that the SGLT inhibitors can do. Susan: Great, so let me start, I'll give you 3 statements. My statements all focus on the use of SGLT2i in the non-diabetic CKD setting, which is a cohort that merits special attention when discussing the benefits of SGLT2i use (Susan)SGLT-2 inhibitors are nephroprotective in diabetic and non-diabetic CKD (TRUE)SGLT2 inhibitors decrease proteinuria in non-diabetic CKD (TRUE)SGLT2 inhibitors are indicated for all etiologies of non-diabetic CKD (FALSE) Explanation for 1 → Statement 1 is TRUE. SGLT-2 inhibitors are in fact nephroprotective in BOTH diabetic and non-diabetic CKD. The CREDENCE trial was the first to specifically examine kidney outcomes in patients with diabetic, proteinuric CKD, and it demonstrated significant decrease in risk for kidney failure and cardiovascular events in patients treated with canagliflozin (Perkovic et al, 2019). As the effects were independent of glucose lowering effects, further studies have been conducted in the non-diabetic CKD setting. DAPA-CKD included patients with both diabetic and non-diabetic CKD and found that the use of dapagliflozin was associated with decreased risk of >= 50% decline in eGFR, ESKD or death from renal or cardiovascular causes (Heerspink et al, 2020). Explanation for 2 → Statement 2 is ALSO TRUE. We do in fact have compelling data that proteinuria is reduced with the use of SGLT2i in non-diabetic kidney disease. Pre-specified analyses from the DAPA-CKD trial demonstrated that dapagliflozin significantly reduced proteinuria in both diabetic and non-diabetic CKD, although the effect was larger in the diabetic subset. Because clinical outcomes were similar with dapagliflozin initiation between diabetic and non-diabetic patients, despite this difference in effect size on proteinuria, it has been postulated that the observed nephroprotection may not actually be related to reduction in proteinuria. Explanation for 3 → Statement 3 was the FALSE statement. In DAPA-CKD, included etiologies of non diabetic CKD were FSGS, minimal change disease, chronic pyelonephritis, chronic interstitial nephritis and hypertensive, IgA, membranous, and obstructive nephropathies. However, patients with lupus nephritis, polycystic kidney disease and vasculitis were excluded. The results of EMPA-Kidney are highly anticipated, in part as it includes a larger number of participants without diabetes, in particular those with glomerular disease, which will hopefully give us more answers about whether these patients will also benefit from SGLT2i initiation. EMPA-Kidney does however also exclude patients with PKD (The EMPA-KIDNEY Collaborative Group, 2022). That was fun, I can't wait to hear more from the rest of our panelists. Moving on to Dr. Mythri now, can you please give us your 2 truths and a lie?Mythri:SGLT2i are the initial therapy for T2DM (FALSE)SGLT2i are beneficial in heart failure with reduced ejection fraction as it reduces both preload and afterload (TRUE)SGLT2i are analogs of Phlorizin (TRUE)Explanation for 1. SGLT2i are not the initial therapy. Initial therapy consists of lifestyle modifications, diet and exercise (American diabetes association guidelines 2021).Explanation for 2. SGLT2 inhibitors promote osmotic diuresis and natriuresis in patients with and without diabetes, and thus may reduce preload. SGLT2 inhibitors may also have vascular effects (including improving endothelial function) that promote vasodilation and thus may also reduce afterload. It has also been postulated that SGLT2 inhibitors may improve myocardial metabolism and thus improve cardiac efficiency. SGLT2 inhibitors promote osmotic diuresis and natriuresis in patients with and without diabetes, and thus may reduce preload (Joshi et al, 2021).Explanation for 3:A natural compound, phlorizin, was isolated from apple trees in the early 1800s and for decades played an important role in diabetes and renal physiology research. The compound is poorly absorbed from the gastrointestinal tract and inhibits both SGLT1 (primarily found in the gastrointestinal tract) and SGLT2. Analogs of phlorizin have been developed that circumvent these two problems. These are the current SGLT2i (Atanasov et al, 2016).Susan: That was great Dr. Mythri, thank you, I feel like I learned so much! Moving on to Dr. Dana, can you give us your 2 truths and a lie?Dana:Awesome, thank you Susan! Alright, please identify the lie from among these statements all concerning potential SGLT2 side effects:SGLT2 inhibitors definitively increase the risk of vulvovaginal candidiasis and may increase the risk of urinary tract infections. (TRUE)SGLT2 inhibitors do not definitively increase risk of bladder cancers. (TRUE)SGLT2 inhibitors definitively increase risk for limb amputations. (FALSE)Do you think you have the answer!?! Let's take a closer look…My first statement, SGLT2 inhibitors definitely increase the risk of urinary tract infections and vulvovaginal candidiasis is TRUE. Multiple studies on SGLT2 inhibitors including a 2018 canagliflozin RCT and a 2013 dapagliflozin RCT have shown 2-4 fold increase in vulvovaginal candidiasis in 10-15% of patients on SGLT2 inhibitors compared with placebo (Neal et al, 2017). A 2019 meta-analysis of over 100 RCTs with SGLT2s compared with other anti-diabetic agents or placebo did NOT show an increase in risk of UTIs for SGLT2s as a group, though there was a signal for increased risk of UTIs specifically for dapagliflozin, mechanistically it is unclear why this would be the case (Donnan et al, 2019). At this time, where there is definitive increased risk of vulvovaginal candidiasis, increased risk of UTI is likely not something you need to counsel your patients on.Alright, moving on, our second statement, SGLT2 inhibitors do not definitely increase risk of bladder cancers is also TRUE. While few cases of bladder cancers have been diagnosed in patients taking dapagliflozin, half of these occurred within the first 6 months, which is thought to be too soon for tumorigenesis promotion by dapagliflozin itself. EMPA-REG trial did not find increased incidence of bladder cancer once event rates that occured within the first 6mo of drug therapy were removed (Kohler et al, 2017). Currently, the FDA recommends ongoing postmarketing surveillance And finally, moving on to our final statement which must be FALSE given the name of the game, the statement says SGLT2 inhibitors definitively increase risk for limb amputations. While the CANVAS program found that in the over 10,000 combined patients from their two major trials there was an increased risk of amputations 6.3 vs 3.4 per 1000 participants with hazard ratio 1.97, these amputations were primarily at the level of the toe or metatarsal, not the limb (Neal et al, 2017). Furthermore, there is ongoing discussion over true risk of amputation attributed to SGLT2 inhibitors as post hoc analysis of empa-reg and CREDENCE, the renal outcomes trial for canagliflozin, no association for increased risk of lower extremity amputation was found (Perkovic et al, 2019). While further investigation into the topic is warranted, we can rest assured that this is our FALSE statement on side effects of SGLT2-inhibitors. Susan: Wow Dana, thanks so much for those very important lessons on SGLT2i side effects, I certainly have a lot of take home points from your discussion! Perfect, now we'll move on to Dr. Sandhya. Please join me in welcoming her to give us our final set of 2 truths and a lie today.Sandhya:Thank you Susan. So here, I will be focussing my 2 truths and a lie on the cardioprotective effects of SGLT2 inhibitors. Without further ado, here are my 3 statements:Statement 1: Increased ketone body production is postulated as one of the mechanisms for the cardioprotective effects of SGLT2 inhibitors (TRUE)Statement 2: Glucose lowering effect and cardiovascular benefits both decline at lower GFRs (FALSE)Statement 3: Sotagliflozin in a combined SGLT2 and SGLT1 inhibitor which has demonstrated cardioprotective benefits (TRUE)Explanations for the above statements: Let me go through the explanation for each statement one by one.Statement 1 is true. The cardioprotective effects of SGLT2 inhibitors may be multifactorial. While they target the traditional cardiovascular risk factors through their glycosuric and natriuretic effects, it is also postulated that SGLT2 inhibitors improve the cardiac metabolism and bioenergetics. 90-95% of cardiac energy is derived from mitochondrial oxidative metabolism for which the predominant fuel is free fatty acids. In a diabetic heart, the metabolic flexibility in terms of substrate utilization is impaired and the myocardium becomes more dependent on free fatty acids as fuel leading to build up of free fatty acid intermediates which lead to lipotoxicity and myocardial dysfunction. SGLT2 inhibitors produce a starvation simulation with reduced insulin and higher glucagon levels which promotes lipolysis and ketogenesis. They also reduce the excretion of ketone bodies by reducing the GFR. These ketone bodies like beta hydroxybutyrate serve as an alternate super fuel for myocardial cells producing ATP more efficiently and help to preserve the mitochondrial integrity and these factors lead to improved cardiac efficiency (Joshi et al, 2021).Now coming to statement 2. The glucose lowering effect of SGLT2 inhibitors does decrease with declining GFRs because the magnitude of glucose excretion and consequently the HbA1c reduction is dependent on the filtered glucose load. This filtered glucose load is high in diabetic patients with normal GFR and reduced in patients with renal impairment thereby leading to reduction in the glucose lowering effect of SGLT2 inhibitors (Kelly et al, 2018). Conversely, the cardioprotective effects of this class of drugs seems to be remarkably preserved at lower GFRs as has been demonstrated in several trials. For example, in the EMPAREG OUTCOME trial, analysis of a subgroup of patients with prevalent kidney disease was done which included type 2 diabetic patients with established cardiovascular disease and an estimated GFR between 30-60 . There was significant reduction in the cardiovascular and all-cause mortality as well as hospitalization for heart failure in this subgroup and this effect was consistent across different categories of GFR (Wanner et al, 2017). So statement 2 is false.So by that logic statement 3 has to be a truth. We often talk about the 4 traditional flozins so I just wanted to throw in a statement about this new subclass within this class of agents. Sotagliflozin is an SGLT2 inhibitor which also inhibits the intestinal SGLT1 transporters. It was originally targeted for use in patients with type 1 diabetes mellitus with the hope that SGLT1 inhibition in the intestine could reduce postprandial hyperglycemia and improve overall glycemic control in these patients. Studies have also shown excellent efficacy for this purpose. However they also showed a higher incidence of Diabetic ketoacidosis episodes. 2 cardiovascular trials were conducted, both of which unfortunately, ended early as they lost funding sometime during the COVID pandemic. The SCORED trial included CKD patients and the SOLOIST-WHF trial included patients who had recently recovered from an episode of decompensated heart failure. I won't go into the strengths and limitations of these trials but they did show benefit in terms of cardiovascular endpoints in the sotagliflozin group compared to placebo (Bhatt et al, 2021; Bhat et al, 2021). The drug isn't commercially available as of now and is not FDA approved yet but it remains as a novel agent within the SGLT2i landscape.Susan (Conclusion by host):Amazing, thank you so much Dr. Sandhya! That was an enlightening discussion on cardioprotection with SGLT2i use. And this has been so much fun! I hope you've all found our conversation really helpful and informative - I certainly know that I have learned a lot from my colleagues today. I can't thank them enough for sharing their time and expertise with us. Be sure to tune in next time for more FOAMed nephrology education.

Providing Kidney Support in the PICU

PICU Doc On Call

Play Episode Listen Later May 29, 2022 43:10

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. I am Pradip Kamat. I am Rahul Damania, a current 3rd year pediatric critical care fellow. I am Kate Phelps- a second year pediatric critical care medicine. We come to you from Children's Healthcare of Atlanta Emory University School of Medicine. We are delighted to be joined by guest expert Dr Stephanie Jernigan Assistant Professor of Pediatric-Pediatric nephrology, Medical Director of the Pediatric Dialysis Program at Children's Healthcare of Atlanta. She is the Chief of Medicine and Campus Medical Director at Children's Healthcare of Atlanta, Egleston Campus. Her research interests include chronic kidney disease, and dialysis. She is on twitter @stephaniejern13 I will turn it over to Rahul to start with our patient case... A 3 year old previously healthy male presents with periorbital edema. Patient was initially seen by a pediatrician who prescribed anti-histamines for allergy. After no improvement in the eye swelling after a two week anti-histamine course, the patient was given a short course of steroids, which also did not improve his periorbital edema. The patient progressed to having abdominal distention and was prescribed miralax for constipation. Grandparents subsequently noticed worsening edema in his face, eyes, and feet. The patient subsequently had low urine output, low appetite and lack of energy patient was subsequently brought to an ED and labs were obtained. Grandparents denied any illness prior to presentation, fever, congestion, sore throat, cough, nausea, vomiting, gross hematuria, or diarrhea. In ED patient was noted to be hypertensive (Average systolic 135-highest 159mm HG), tachycardic (HR 130s-140s), breathing ~20-30 times per minute on RA with SpO2 92%. Admission weight was recorded at 16.5Kg. Physical exam showed periorbital edema, edema of ankles, there was mild abdominal distention (no tenderness and no hepatosplenomegaly), heart and lung exams were normal. There were no rashes on extremities. Labs at the time of transfer to the PICU: WBC 10 (62% neutrophils, 26% lymphocytes) Hgb 7.2, Hct 21, Platelets 276. BMP: Na 142/K 8.4/Cl 102/HCO3 19/BUN 173/creatinine 5.8. Serum phosphorus was 10.5, Total Ca 6.4 (ionized Ca= 3.4), Mag 2.0, albumin 2.6, AST/ALT were normal. An urine analysis showed: 1015, ph 7.5, urine protein 300 and rest negative. Chest radiograph revealed small bilateral pleural effusions. After initial stabilization of his hyperkalemia-patient was admitted to the PICU. PTH intact 295 (range 8.5-22pg/mL). Respiratory viral panel including for SARS-COV-2 was negative. C3 and C4 were normal. A nephrotic syndrome/FSGS genetic panel was sent. A renal US showed: bilateral echogenic kidneys and ascites (small volume). Pradip: Dr Phelps what are the salient features of the above case presented? Kate Phelps: This patient has a subacute illness characterized by edema, anemia, and proteinuria. His labs show that he has severe acute kidney injury with significantly elevated BUN and Creatinine, hyperkalemia, hyperphosphatemia, and hypocalemia. Rahul: Dr Jernigan welcome to PICU Doc on Call Podcast. Thanks Kate, Rahul and Pradip for inviting me to your podcast. This is a such a great way to provide education and it is my pleasure to come today to speak about one of my favorite topics, pediatric dialysis. I have no financial disclosures or conflicts of interest and am ready to get started. Rahul: Dr Jernigan as you get that call from the ED and then subsequently from the PCCM docs, as a nephrologists whats going on in your mind ? When I get the call from the outside hospital my first job is to make sure the patient is safe and stable for transfer to a tertiary care center. This includes concern about airway, breathing and level of alertness. From a renal standpoint, I am worried about elevated blood pressure, electrolyte abnormalities, in this case primarily the hyperkalemia, and fluid...

Into the Weeds (Part 2): Intrinsic Acute Kidney Injury with Dr. Kim Thielen

Play Episode Listen Later Mar 25, 2022 82:59

In this podcast, Dr. Kim Thielen, a nephrologist/kidney specialist with Minnesota Kidney Specialists joins us today to continue part 2 of our discussion on acute kidney injury, as we wade further "into the weeds" discuss intrinsic renal disease. This episode will break down hallmark urinary findings and further subdivide intrinsic concerns into bland, nephrotic and nephritic, various causes, and treatment. Enjoy the podcast! Objectives: Upon completion of this podcast, participants should be able to: State the 3 types of urinary analysis findings related to instrinic acute kidney injury. Describe etiology of presentation of each type of intrinsic acute kidney injury. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics. Any re-reproduction of any of the materials presented would be infringement of copyright laws. It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES: *See the attachment for additional show information. Intrinsic Kidney Injuries: Urinary analysis findings- Bland Urine: no protein - Nephrotic: protein - Nephritic: protein and blood Hallmark Urinary Findings: Casts - Tamm Horsfall Protein : Mucoprotein made by tubular epithelial cells that precipitate out and congeal to form casts on whatever is in the cells at the time. (i.e. RBCs, WBCs, tubular debris) Bland Urine States- Crystalline Induced Renal Injury: obstruction and infllamatory response - Uric Acid Neuropathy (Most common) - Cancers, lymphomas, etc. - Drugs: acyclovir, methotrexate, protease inhibitors, etc. - Toxins: Ethylene glycol - Bland Urine Disease states: results from injury to tubules, instertim or pre glomerular blodd vessels, not the filters of the kidney - Interstital Nephritis - Hallmark: pyuria and WBC casts - Biopsy: inflammatory infiltrate - Causes: viral, PPIs, Adenover, mizalamin, etc., Checkpoint inhibitors - Acute Tubular Necrosis - Hallmark: tubular epithelial cell cast - Granular: (course or fine) diagnostic of ATN - Biopsy: denuded dilated tubular cells - Causes: #1: Ischemia; toxins, drugs, contrast dye; pigment injury. myoglobin - What about contrast dye? - Categorized under ATN - Per Dr. Thielen, plays a role, but injury is not solely dependent on dye alone. - Hepatorenal Syndrome: ischemic injury to the kidney due to unopposed vasocontstriction - Ace inhibitors cause unopposed efferent vasoconstriction + nonsteroidals cause unposed afferent vasoconstriction = no glomerular perfusion pressure - Multiple Myeloma - Hallmark: Light chain cast nephropathy or myeloma kidney - Light chains precipitate out causing obstruction, inflammatory response and causes tubular damage - Presentation: older possibly with anemia, bone pain and elevated creatinine with a bland urine. - Protein to creatinine ratio: + for protein (non albumin) - Dipstick: (which measures for albumin and not light chains) will be negative for protein aka bland urine - Hypertensive Nephrosclerosis - Small vessel vascular disease - Blood vessels prematurely atherosclerosis causing glomerular drop out and scarring of the interstim - Scleroderma - Limited cutaneous systemic sclerosis - Diffuse cutaneous systemic sclerosis: 60-80% have renal injury from disease state itself - FANA positive - Concern for Scleroderma Renal Crisis = medical emergency - AKI, moderate to severe HTN and bland urine - Uncontrolled accumulation of collage, thickens vascular walls, narrowing and renal ischemia - Occurs in 10-15% of those with Diffuse Cutaneous Systemic sclerosis and happens early in disease - Left untreated: renal failure in 1-2 months and death in 1 year - Treatment: ACE Inhibitor Nephrotic Urine States - Urine protein: albumin excretion greater than 3.5g in 24 hours - Nephrotic Syndrome: - Present with 3 things (nephrotic range protein, hypoalbuminemia, peripheral edema) - Hyperlipidemia: due to increased hepatic lipogenesis - Increased risk of renal disease and arthroscleratic - Venous thrombotic disease: - Loose proteins other than albumin and develop a hypercoagulale state - Renal and peripheral venous thrombosis - Lipiduria (forms fatty casts, looks like a latese cross under microscope) -Pathophysiology or nephrotic syndrome - Glomerular capillary wall - 3 layers that work as a glomerular filtration and responsible in the filtration between blood and urine - Fenestrated Capillary Enothelial cells (fenestrations allow plasma through to the basement membrane) - Glomerular Basement Membrane (maintains glomerular filtration barrier; negatively charged, repels albumin) - Epithelium: Podocytes (Have highly specialized foot processes that connect and form slit diaphragms; Slit diaphragm important for the efficient flow of small solute and water) - Anything that messes with any of these layers: nephrotic proteinuria - Nephrotic Disease States: - Biopsy: anyone with nephrotic proteinuria (besides diabetics) 1) Light microscopy: high overview 2) Immunofluorescens: looks for nephritic component and identif immunce complexes 3) Electron microscopy: (EM) helps look at the ultrastructure and better identify immune deposits - Diabetic nephropathy - Leading cause of kidney disease in U.S. and western society - Responsible for 30-40% of all ESRD causes - Hyperglycemia: produces inflammatory responses, oxidative stress, and injures the podocytes and deposits that charge and affect the ability of the kidney to filter. - Amyoidosis - Organize into betapleted sheets and produce spikes of the capillary uniion and poke through the GF membrane - Easily identified by apple green birefringence on congo red - Terminal illness - Present with HTN, cardiac effects and elevated creatine - Nephrotic Disease states based of histologic appearance - Diagnosed by histologic appearance but does not determine the etiology - Minimal Change Disease - Fairly common - Minimal change under light microscope - EM: podocytes are abnormal, fused, no unique cell-cell junction - Primary: Immune generated circulating facture; alters the cytoskeleton of the podocytes - Secondary - Nonsteriodal - most common cause of secondary minimal change disease - Gama interferon - Hodgkin's lymphoma - Allergy: 30% of minimal change have associate allergy (mechanism unknown) - Presentation - Sudden onset (days to weeks) - Marked edema and hypoablbuminemia - 60% have normal blood pressure, 82% have normal creatinine - Focal Segmental Glomerulosclerosis (FSGS) - primary and secondary - Most common cause idopathic nephrotic syndrome in adults - Primary glomerulonephritis in the US that causes ESRD - Widespread podocyte injury - Primary: circulating factor that messes with regulation of foot process and adhesion to the glomerular basement membrane (afffect all podocytes) - Present with nephrotic syndrome and rapid progression - HTN and elevated creatinine - Secondary: the visceral epithelial cells don't replicate - Nephron loss or obesity or direct foot process injury - Cannot replicate (podocytes), leads to decreased to podo denisty at specific areas (focal injury) - 2/3 of all cases FSGS - Present: with slowly increasing proteinuria and kidney impairment over time - Causes: interferon, bisphosphonates, talc, anabolic steroids - Genetics: gene mutations that encode for the slit diaphragms of the podocytes (affect all podocytes) - Present in Childhood: full blown nephrotic and progress rapidly to ESRD Membranous Nephropathy - Most common cause of nephrotic syndrome in caucasion adults - 80% present with nephrotic but develops more slowly to ESRD - Primary: Major antigen identified - antibody to trans-membrane receptor that is highly expressed on the glomerular podocyte - Secondary: Cancers (lung, breast, GI), Lupus, Thyroiditis, Hep B, Syphilis, Nonsteroidals, Monoclonal Antibodies Nephritic Syndrome - Hematuria and proteinuria - Hematuria: blood from kidney or outside the kidney - Outside the kidney: look the same - Inside the kidney: dysmorphic red cells - Present: - Renal impairment for days to weeks - Edmatous, HTN and look critically ill - Vasculitis, sinusitis, oral ulcers - Pulmonary renal syndrome: short of breath or hemoptysis - Skin changes: bruising , bleeding, purpura - Myalgias and arthritis - Urine: - Hallmark: red blood cell casts (polymorphic red cells) - dipstick + for blood - elevated proteinuria - Biopsy: nephritic and + urine Nephritic Disease States (based on immunofluorescence staining) - Pauci Immune Disease - Ankle vasculitis, common - A paucity (little amount) of immune complexes - See black on imaging - Lab work: check on ANCA and peripheral eosinophils - Anti-GBM Disease - Renal limited, or classic pulmonary renal: Good Pasture's - linear staining of the glomerular basement with anti IGG (looks like a ribbon on a package) - Treat with cytotoxic agents - Immune Complex - Starry sky pattern - Glomerulus looks dotted with stars - Stars = immune complex definition - Diseases: Lupus (FANA), Post Infectious GN, Membranous Proliferative GN - IGA Nephropathy - Most common cause of glomerulonephritis in the world - Presentation: - Peak incidence is the 2nd and 3rd decades of life - 40-50% gross hematuria with upper respiratory and GI illness - Risk Factors for Progression: - younger age or hypertension at time of presentation - > 1g proteinuria - Elevated creatinine at time of presentation Thanks for listening.

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The Kidney Fighter battles FSGS

Hope with Jonathan Podcast

Play Episode Listen Later Mar 20, 2022 64:03

#kidneyfailure #fsgs #kidneyfighter

FSGS: Pathogenesis and pathophysiology | With Dr Sanjeev Sethi

The Black Carnivore Podcast

Play Episode Listen Later Mar 9, 2022 14:20

While focal segmental glomerulosclerosis (FSGS) is rare overall, it is one of the most common glomerular diseases on Europe, North America and Latin America. Rather than being a specific disease entity, it is a pattern of injury that takes various forms that, together with the clinical presentation, have important implications for treatment and prognosis. Join Dr Sanjeev Sethi, pathologist at the Mayo Clinic, Rochester, Minnesota, USA, for an overview of our current understanding of how FSGS develops and presents. By completing this module you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: 1. McGrogan A, Franssen CF, de Vries CS: The incidence of primary glomerulonephritis worldwide: A systematic review of the literature. Nephrol Dial Transplant 26: 414–430, 2011 2. Sim JJ, Batech M, Hever A, Harrison TN, Avelar T, Kanter MH, Jacobsen SJ. Distribution of Biopsy-Proven Presumed Primary Glomerulonephropathies in 2000-2011 Among a Racially and Ethnically Diverse US Population. Am J Kidney Dis. 2016 Oct;68(4):533-544. 3. Rosenberg AZ, Koop JB. Focal segmental glomerulosclerosis. Clin J Am SOc Nephrol. 2017;12(3): 502-517. 4. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1–S276. 5. Lepori N, Zand L, Sethi S, Fernandez-Juarez G, Fervenza F. Clinical and pathological phenotype of genetic casues of focal segmental glomerulosclerosis in adults. Clinical Kidney J. 2018;11 (2): 179-190. Disclosures: Dr Sanjeev Sethi has no relevant disclosures to report at this time. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME and validated by an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

Can the Carnivore Diet Reverse Kidney Disease?

Play Episode Listen Later Sep 13, 2021 51:31

Tarik lost 45lbs, reversed pre-diabetes, high blood pressure and most importantly is healing his Focal Segmental Glomerulosclerosis (FSGS). Focal segmental glomerulosclerosis (FSGS) is a rare disease that affects the filters in your kidneys. When these filters are scarred, they are unable to filter your blood, which can lead to kidney damage and failure. Treatment for FSGS focuses on treating the symptoms and preventing any additional scarring. His doctors said they had never seen such improvement and to keep doing what he's doing. He hopes to be off medications very soon. Tarik is also finally strong enough to pursue his fitness goals so check out his workouts on his YouTube channel.

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Plant-based diets: Can they work for kidney patients?

Hot Topics in Kidney Health

Play Episode Listen Later Jul 29, 2021 47:03

Today's hot topic is plant-based diets. For some kidney patients, eating more plant-based foods may help prevent and slow the progression of chronic kidney disease. But what exactly does a plant-based diet entail and how do you know if this diet is right for you? In this episode, you will hear from: Brittany Sparks, RDN, CSR: Brittany Sparks is a registered dietician and board-certified specialist in renal nutrition. Her private practice focuses heavily in helping those with chronic kidney disease. She provides evidenced based medical nutrition therapy and enjoys speaking nationally on nutrition-related topics. She also creates recipes and teaches how to follow through with nutrition recommendations in the kitchen. Eric Singer: Eric Singer was diagnosed with focal segmental glomerulosclerosis (FSGS) in 2007 and currently advocates for whole food, plant-based diets. Additional resources: Finding a dietitian - https://bit.ly/378LNtG Finding a dietitian - https://bit.ly/3xcfa8Q KDOQI guidelines: https://bit.ly/3rIxxRC Plant-based Recipes: https://bit.ly/3ycxNLt More plant-based info: https://bit.ly/3BUr8aP

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Metal To The Masses Ep. 5. Malcom Dead Guy. Overcoming Two Kidney Transplants With a PMA

Metal To The Masses Podcast

Play Episode Listen Later Jul 17, 2021 54:36

On this weeks episode I was joined by a long time friend Malcom Valdivia, owner of Dead Guy Designs. Malcolm has a truly inspiring story on how he has attacked his rare autoimmune disease, FSGS, and his two kidney transplants. This man is a warrior and has helped my personally put things in life into perspective. This is an episode you won't want to miss.

overcoming metal masses malcom kidney transplants deadguy fsgs

Lollar Blackface Strat Pickups Demo & Giveaway

The Nephrotic Syndrome Foundation Podcast

Play Episode Listen Later Jun 23, 2021 20:28

Lollar Pickups Blackface Strat Pickups Demo & Giveaway - In this video I switch out the original pickups from a Squier Strat and replace them with the Lollar Pickups Blackface Strat Pickups. As mentioned in the video, I will be giving away: - A Squier Strat Guitar setup by pro luthiers at Guitar OR in Calgary - Lollar Pickups Blackface Strat set - Custom Picks from Tree Picks (who will also plant some trees as well) Click this link to enter the competition: https://fretsuccess.com/lollar-blackface-giveaway . Competition will end on 23 Jul 2021 at 12pm MST. Check them out the pickups here: https://www.lollarguitars.com/lollar-stratocaster-pickups/strat-blackface Watch my interview with Jason Lollar here: https://youtu.be/Y3tS43_LsbM Listen to the podcast version by searching for the Fret Success Guitar Show on your favourite player. #lollarpickups #custompickups #stratpickups #stratocaster #guitargear2021 #pickups #FSGS #fretsuccess #guitarteacher #calgary #guitartone #customguitars #treepicks --- Support this podcast: https://anchor.fm/the-fret-success-guitar-show/support

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Grace and Courage- Mikaela's Story

Play Episode Listen Later May 28, 2021 54:07

(2:06) Feeling alone and reaching out,…(2:55) The events leading up to diagnosis…(6:11) “When I was in the middle of it, I just felt so uncomfortable. I felt so sick. I was so tired, and I felt so grateful that I was older and able to talk when I got diagnosed because hearing it was a kid's disease… I couldn't imagine going through it when I was younger, and I couldn't vocalize to other people how I felt.”(8:24) Swelling, school, Covid, and a supportive family…(11:05) Great doctors and great teachers…(13:23) “My answer would be my kidneys hate me or my kidneys are misbehaving just cause they're doing their own thing and it was easier sometimes not getting all the way into it.”(16:55) Plans after graduation…(18:30) “I became so interested in how intertwined the body is, how one little thing kind of effects everything else. And that just fascinated me. So I was like, I get to learn more about that. I get to help people, which I just love doing.”(19:41) Horseback riding…(21:17) Finding the right meds to get to healthy kidney function…(27:18) Losing a horse…(29:31) Figuring out correct dosing routines…(37:25) Talking about blood draws and IVs…(41:53) “The attending that was on my case would make a list in the morning of things to do. So, I would stay motivated. They offered to discharge me when I was really sad. When my horse passed away, they were like, you can go home and you can just come back in a few days.”(44:56) Boston Children's Hospital…(47:09) What were things that made school easier and plans for college…(49:58) Advice from Mikaela… “You need to reach out. You need to talk to people. You're going to collapse if you try to carry this all on your own.”

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New way to get involved in research

Hot Topics in Kidney Health

Play Episode Listen Later May 18, 2021 25:12

In this episode, we talk about the NKF Patient Network, an online registry for kidney patients at any stage of kidney disease. This network is an exciting new and easy way to for patients to be part of the effort to improve the lives of people affected by kidney disease everywhere. In this episode, you will hear from: Dr. Kerry Willis: Dr. Kerry Willis is Chief Scientific Officer at the National Kidney Foundation and co-developer of the Patient Network. Dr. Willis received her PhD in Molecular Genetics from New York University Medical Center and has been with NKF since 1998. She founded NKF's Medical Activities division and made it a priority to identify and apply the best science available to improve kidney disease patient care and outcomes. Dr. Lesley Inker: Lesley A. Inker, MD, MS is a nephrologist who serves as Director of the Kidney and Blood Pressure Center and Director of the Kidney Function and Evaluation Center at Tufts Medical Center. She is also chair of the NKF Patient Network Steering Committee. Dr. Inker's research has established her as an expert in the implementation of estimated glomerular filtration rate by clinical laboratories, as well as an expert in estimating and measuring kidney function. Dr. Alex Chang: Dr. Alexander Chang is a nephrologist, assistant professor of Clinical Research and co-director of the Kidney Health Research Institute at Geisinger. He is engaged in research dedicated to preventing and delaying CKD progression and its complications. His research areas include interventional studies focused on improving lifestyle behaviors in patients with hypertension and patients with early CKD; using observational data from Geisinger and other large cohorts to identify potential avenues to improve management of CKD and hypertension; and health system interventions to improve early recognition and optimized management of early kidney disease. Dr. Alex Chang also serves as NKF Patient Network PI for Geisinger site. Curtis Warfield: Curtis Warfield is a kidney patient and patient stakeholder on the Patient Network Advisory Committee. In 2012 he was diagnosed with Stage 3 Chronic Kidney Disease (CKD) due to FSGS. In 2016, he received a kidney from his daughter's college sorority sister. Curtis, a passionate advocate for CKD, organ donation and living donors provides peer counseling with the NKF Peer Program. He also serves as member of NKF's Kidney Advocacy Committee, where he advocates with members of Congress for kidney and organ donor issues. Cari Maxwell: Cari Maxwell is a kidney patient and patient stakeholder on the Patient Network Advisory Committee. She was diagnosed with Autosomal Dominant Polycystic Kidney Disease in 1989 and has been an active supporter of the National Kidney Foundation. She hopes that through her commitment to the awareness of chronic kidney diseases, others will take an active role in their health journey through early detection, healthy choices, and becoming a strong voice themselves in advocating for those that cannot. Learn more about the NKF Patient Network by visiting www.kidney.org/nkfpatientnetwork.

The Gretchen Jackson Story!

Hope with Jonathan Podcast

Play Episode Listen Later May 17, 2021 64:19

Join us as we interview Gretchen Jackson and she will share her incredible story with battling FSGS, kidney disease, doing home peritoneal dialysis and more! We will also advocate for a living kidney donor! Don't miss it! https://m.facebook.com/Kidney4gretchen/ https://instagram.com/kid.neyforgretchen?igshid=9rsgxyeyp4kf

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Finding Wellness Through Functional Medicine- Nicki's Journey With Nephrotic Syndrome

The Nephrotic Syndrome Foundation Podcast

Play Episode Listen Later Apr 22, 2021 66:32

(2:30) How Nicki got connected to the NSF Peer Team and the power of a community…(5:11) Nicki's nephrotic syndrome journey begins…(9:57) A Google search reveals scary possibilities…(11:32) A trip that revealed so much…(14:07) “So I was wearing these compression socks, and I was in the middle of a crowded subway with all of my master's program students, and I started feeling faint.”(17:37) Shock and then grieving sets in…(19:48) “Nephrotic syndrome was a wake-up call to healing from that persona and that lifestyle of thinking I always needed to achieve, always needed to be perfect, always needed to be president of everything and working on something and never take a break. And I think that's what stressed my body out a lot in the first place.”(20:46) The year after graduation and the experience with Prednisone…(24:52) No formal diagnosis…(26:27) An autoimmune component and a glimmer of hope…(29:47) Several medications, side effects, and a strong desire to reach remission…(30:44) A link between gut health and nephrotic syndrome…(33:25) Finding an incredible nephrologist who is willing to look at all options…(35:40) It takes the right team effort…(38:16) “I went from sitting on the couch all day to now functioning, like a normal person, having energy to go above and beyond during my days and achieve so many things that I never thought I could do.”(40:33) Mushrooms, coffee, and lifestyle…(46:34) “What else can be addressed to lessen inflammation, to make me have energy and feel better and have a good quality of life through this diagnosis?”(50:20) A trifecta for healing…(51:48) The personal side of things…(56:39) “It's an easy thing to do to let your life become nephrotic syndrome for a little while.” Andi, Jeremy, and Nicki comparing experiences…(59:45) Family support, trust, and rebirth…(1:02:52) Future goals and a piece of advice...To reach out to Nicki:Instagram @nephnicki Blog nephnicki.comOther resources mentioned by NickiMy root cause practitioner is Emily Morrow: @emilymorrow on Insta Her website is theemilymorrow.comShe is currently filled with individual clients but works with women in her group program called Root Cause Formula that accepts applications. She also offers courses in blood chemistry and lots of free resources to guide one's journey. She is certified as an FNTP (Functional Nutritional Therapy Practitioner) and IHP (Integrative Health Practitioner). My life coach is Elise Dean, and she coaches with Blush Life Coaching: @joinblush on Insta and joinblush.comThe service was created by Kali Rogers, Founder & CEO and a life coach, and Elise works alongside Kali as Creative Director and Senior Life Coach. While the team is comprised of women, I believe they will coach anyone! Part of their mission is to promote affordable coaching/mental health options (I could see it as a great resource for the Moms out there, in addition to patients!)

Welcome to Fueling the Pursuit by UCAN

Fueling The Pursuit

Play Episode Listen Later Mar 21, 2021 6:36

In this short welcome episode, you will meet our hosts, Jon Rankin and Bryan Green, and learn more about what to expect in Season 1 of Fueling the Pursuit.Hosts:Jon Rankin - gobemore.co | @chasejonrankinBryan Green - maketheleapbook.com | @maketheleapbookPresented By:UCAN - ucan.co | @genucanYour Personal Best Awaits

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Jarin Winterhalt - Interview with a Guitar Repair Luthier (S3 Ep1)

The Nephrotic Syndrome Foundation Podcast

Play Episode Listen Later Feb 1, 2021 49:40

Jarin Winterhalt | Guitar Repair Luthier - Guitar O.R. Calgary. It's not every day that you get to sit down with someone who has an impact on so many guitars on an everyday basis. We can sometimes neglect our guitars and even not know how to make them perform their best. Jarin Winterhalt has figured this out over his many years in the world of guitar repair and maintenance Jarin is a guitar repair luthier and we talked about his career so far, interesting guitars he's worked on and tips for things to watch out for. Watch the full interview. Check Out Jarin's website for more information: www.guitaror.ca #guitar #guitarlessons #jarinwinterfelt #guitarrepair #FSGS #fretsuccess #guitarteacher #calgary #guitartone --- Support this podcast: https://anchor.fm/the-fret-success-guitar-show/support

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NSF Launches a Podcast!

Play Episode Listen Later Jan 26, 2021 50:07

“These are just stories we're sharing, but you know, they all could triggera thought that maybe a parent might then be able to go follow up on andask a provider about...”—Andi CallawayIn this episode of The Nephrotic Syndrome Foundation podcast, we give youa glimpse into our vision and the “Why” behind our efforts. We're “setting thestage” for the many future stories you'll hear.We believe there are many warriors in the nephrotic syndrome world—frompatients, to parents, siblings, and providers—each with wisdom to share.Show Notes(3:25) Andi and Jeremy sharing what it feels like to share their own stories...(6:53) “I think that's one of our big goals of the podcast, is just to reallybring people together and show that there are so many things that we'veall had to go through.” Finding unity in shared experiences...(11:27) Reflecting back and being in the trenches—both contribute value.(15:04) “When you're having a great month, you don't need to tap into this.Go enjoy your month.” A podcast is a resource that can meet you whereyou're at.(18:43) Cynthia's inspiring journey...(21:34) Wilson's and Jeremy's experiences of not wanting one moreprocedure.(25:53) A shoutout to Dr. Orloff and Jon Rankin...(29:01) The Just One Challenge and how it fits into the nephrotic community...(32:27) “When I say that they are warriors, I believe it to the core of mybeing.”(35:22) What's the vision for the podcast six months and two years from now?(39:37) Getting something you believe in off the ground—chatting about thechallenges of starting the podcast.(43:10) Flashbacks, PTSD, and self-care...(47:22) All the types of guests...(59:55) Ways to get involved...

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Simon Pellett Interview - Music On Your Own Terms Podcast - Fret Success Guitar Show (S2 Ep8)

Play Episode Listen Later Dec 5, 2020 47:43

I caught up with Simon Pellett from the Music On Your Own Terms Podcast in this latest episode of the Fret Success Guitar Show. We talk his background, guitars, tips and mental health in the industry. Find Out More Here: https://musiconyourownterms.com #guitar #guitarlessons #FSGS #fretsuccess #guitarteacher #calgary #guitartone #customguitars www.fretsuccess.com --- Support this podcast: https://anchor.fm/the-fret-success-guitar-show/support

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Nick Johnson Acoustic Fingerstyle Guitarist Interview - Fret Success Guitar Show (S2 EP7)

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Play Episode Listen Later Nov 16, 2020 46:07

I caught up with Nick Johnson, acoustic fingerstyle guitar master in this latest episode of the Fret Success Guitar Show. We talk his background, guitars, tips and even his tab guy pulling a prank on him. This guy is a player you need to let into your life pronto!! Find Out More Here: www.nickjohnsonacoustic.com #guitar #guitarlessons #nickjohnson #fingerstyleguitar #pickups #FSGS #fretsuccess #guitarteacher #calgary #guitartone #customguitars --- Support this podcast: https://anchor.fm/the-fret-success-guitar-show/support

Lollar Pickups - Tele Special Pickups Demo - Fret Success Guitar Gear 2020