@varunkumarbandi

Nephrology consultant, #FOAMed, photography lover, and a traveller

 Vijayawada, India
Joined June 2010
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NC-004 | Albuminuria is the "A" in CKD staging and the earliest risk signal 💧 UACR categories: A1 <30 mg/g A2 30–300 mg/g A3 >300 mg/g Use a first-morning sample. Confirm in 2 of 3 samples over 3–6 months before you label it. #VKBneph #NephTwitter
Visual abstract NC-004: Albuminuria categories. A1 less than 30 mg/g, A2 30 to 300 mg/g, A3 more than 300 mg/g. Confirm with 2 of 3 samples over 3 to 6 months, rule out transient causes, screen with UACR not dipstick.

ALT Visual abstract NC-004: Albuminuria categories. A1 less than 30 mg/g, A2 30 to 300 mg/g, A3 more than 300 mg/g. Confirm with 2 of 3 samples over 3 to 6 months, rule out transient causes, screen with UACR not dipstick.

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NC-004.2 | Units trap: 30 mg/g ≈ 3 mg/mmol 300 mg/g ≈ 30 mg/mmol. Dipstick protein misses most moderately increased albuminuria, so screen with UACR.
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NC-004.3 Albuminuria predicts kidney failure, CV events and death independent of eGFR. A ~30% fall in UACR on treatment tracks with lower kidney risk. Screening with UACR must to stage CKM risks, repeat annually Screen everyone with diabetes or hypertension yearly. @goKDIGO
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Varun Kumar B MD, DM, FISN, FASN retweeted
Hany Ragy@Hragy23h
Prevention is a low hanging fruit that we are leaving to rot! @ISHBP #ISH_ECS2026 just mark the targets, teach the public/patients, use all available tools , there should be no COI’s or turf wars , focus on the people.
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NC-003 | Cystatin C: the second opinion on eGFR 🔬 Made by all nucleated cells, largely independent of muscle mass. Creatinine + cystatin C (eGFRcr-cys) is the most accurate. KDIGO 2024: use it when eGFRcr may be wrong or decision is high-stakes. #VKBneph #NephTwitter
Visual abstract NC-003: Cystatin C versus creatinine. Creatinine comes from muscle, is affected by muscle mass, diet and secretion-blocking drugs. Cystatin C comes from all nucleated cells, has minimal muscle and diet effect, but is affected by thyroid, steroids, obesity, inflammation and smoking. The combined creatinine–cystatin C equation is most accurate.

ALT Visual abstract NC-003: Cystatin C versus creatinine. Creatinine comes from muscle, is affected by muscle mass, diet and secretion-blocking drugs. Cystatin C comes from all nucleated cells, has minimal muscle and diet effect, but is affected by thyroid, steroids, obesity, inflammation and smoking. The combined creatinine–cystatin C equation is most accurate.

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NC-003.2 | Cystatin C has its own confounders: thyroid dysfunction, high-dose corticosteroids, obesity, inflammation, smoking. That is why the combined equation, not cystatin C alone, is preferred.
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NC-003.3 | When eGFRcys is much lower than eGFRcr, outcomes track the lower number: higher risk of death, CV events and drug toxicity. Don't average it away. Ref: KDIGO 2024 CKD guideline @goKDIGO
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NC-002 | Creatinine is a GFR marker, not GFR 🧪 Every eGFR assumes steady state, average muscle mass and average tubular secretion. Break one and eGFR misleads. Use race-free CKD-EPI 2021. Confirm with cystatin C when it matters. 🧵 #VKBneph #NephTwitter
Visual abstract NC-002: Creatinine is a marker, not the GFR. Three assumptions behind eGFR: steady state (invalid in AKI), average muscle mass (low mass makes eGFR overestimate GFR), average tubular secretion (trimethoprim, cimetidine, dolutegravir, cobicistat raise creatinine without lowering GFR). Bottom line: use race-free CKD-EPI 2021 and add cystatin C when it changes management.

ALT Visual abstract NC-002: Creatinine is a marker, not the GFR. Three assumptions behind eGFR: steady state (invalid in AKI), average muscle mass (low mass makes eGFR overestimate GFR), average tubular secretion (trimethoprim, cimetidine, dolutegravir, cobicistat raise creatinine without lowering GFR). Bottom line: use race-free CKD-EPI 2021 and add cystatin C when it changes management.

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NC-002.2 Creatinine ↓ so eGFR overestimates true GFR: low muscle mass from frailty, amputation, cirrhosis, malnutrition or a long ICU stay. A "normal" creatinine in a sarcopenic patient can hide real CKD.
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NC-002.3 Outside steady state eGFR is meaningless. In AKI, follow the creatinine trend and urine output (KDIGO criteria). Ref: Inker LA et al. NEJM 2021;385:1737–49 @goKDIGO
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#ISNCON25 🗣️ Dr Prabir Roy Chaudhury   💥 Impact of CKD ✨ Greater impact on health and economics than other NCDs ✨ Sharpest rise among NCDs in 3 decades! @isn_india @ISNkidneycare @Narayansgpgims @sudeepprakash1 @proychaudhuryMD
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#ISNCON25 🗣️ Dr Prabir Roy Chaudhury   💥 CKD is Deadly! ✨ Fastest rise in premature deaths ✨ Mortality risk of 44 yr old dialysis pt similar to 75 yr old person! @isn_india @ISNkidneycare @Narayansgpgims @sudeepprakash1 @proychaudhuryMD
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#ISNCON25 🗣️ Dr Katherine Tuttle    💥 Positive effects of Semaglutide in CKD and CKM factors 💥 FLOW- terminated early due to better outcomes @isn_india @ISNkidneycare @Narayansgpgims @sudeepprakash1 @iamnephrologist @DrPallaviPrasad @dakidneydoc @KatherineTuttl8
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#ISNCON25 🗣️ Dr Katherine Tuttle  ✨ CKD awareness is very low in. Increases with presence of CV disease ✨ 80% unaware of their condition!! ✨ Screening for proteinuria only in 90%! @isn_india @ISNkidneycare @Narayansgpgims @sudeepprakash1 @KatherineTuttl8
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#ISNCON25 🗣️ Dr Katherine Tuttle    💥 Guideline adherence pretty low too ✨ ACEi/ARB in 60-70%. Continued only in 40%!! ✨ MRA in < 10%  ✨ SGLT2i only in 20% ✨ GLP1RA in 10-20 % @isn_india @ISNkidneycare @Narayansgpgims @sudeepprakash1 @KatherineTuttl8
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South cyclone zooms into finals of @Isncon25 cricket leagues @Isncon25 @isn_india #ISNCON25
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