14Jul26

Apps & Tools:

• Bevel AI Health Coach
• EKFC eGFR Calculator — based on NEJM (2023)
  
  
  

  
  
  

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Reading & Listening:

• Channel Your Enthusiasm — Chapter Twenty-Two: Introduction to Disorders of Osmolality
• Body fluid dynamics: back to the future
  
  
  
  
  

12Jul26

Links:

• Freely Filtered by NephJC: Hyponatremia Interventional Trial
• OpenEvidence - Real-time medical evidence grading.
• egfr.app - 17+ validated equations.

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Leaping into the week-end with a potassium of 9.5

Intern: How much calcium should we give?
Me: All of it. pic.twitter.com/x2p1xZaexE

— Joel M. Topf, MD FACP (@kidney_boy) July 10, 2026

ChatGPT for Clinicians, Nils Frahm’s All Melody, and Medieval Drone Society III

AI:

• ChatGPT for Clinicians — OpenAI is offering a clinician-focused version free to verified U.S. physicians, NPs, PAs, and pharmacists. Also launching HealthBench Professional, an open benchmark for clinical AI tasks.

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Music:

All Melody by Nils Frahm

The Medieval Drone Society III by Laura Cannell

Act Early on CKD, Mac Energy Apps, a Magic Tray, and Years of Coffee Posts

Nephro:

• Act Early on CKD — A model for the effect of various medications on the progression of CKD.

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Apps:

• App Tamer — Cuts background CPU use on your Mac to save battery and fan noise.
• QuitAll — One-click quit for all your open Mac apps.

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Gear:

• Magic Tray — A frame to hold your Magic Keyboard and Magic Trackpad.
• Ringo — A water bottle which holds your iPhone.

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• I've posted A LOT about coffee over the years.

Nils Frahm, Max Richter, Jóhann Jóhannsson, Ólafur Arnalds, Einaudi, and Aleksi Perälä

Music:

Felt (Special Edition) by Nils Frahm

From Sleep by Max Richter

Orphée by Jóhann Jóhannsson

re:member by Ólafur Arnalds

Elements (Deluxe) by Ludovico Einaudi

Rays by Aleksi Perälä

Music and Espresso

• It's a three espresso morning.

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Music:

Northspring by The Last Ambient Hero — Four-track ambient album via Bandcamp.

Murmurations by Ruby Colley

Smooth Jazz Piano — Spotify playlist by funkyjlo.

Filspari Gets FDA Approval for FSGS, New Ambient Playlists, Phloe, and Piano in the Background

Nephro:

• Filspari Approved for FSGS — Sparsentan is the first and only FDA-approved medicine for focal segmental glomerulosclerosis. The DUPLEX trial showed a 46% reduction in proteinuria vs. irbesartan at 108 weeks.

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Music:

New Ambient — Spotify's ambient playlist. Fresh releases for focus and drift.

Piano in the Background — Spotify editorial. Soft piano for working.

Max Cooper: Solace in Form — Curated by Max Cooper.

Les Idées by Phloe — On Kordel Records via Bandcamp.

eyeSCANdy, the LIBERATE-D Trial, Process Knowledge, and 20 Years of Kidney Notes

Nephro:

• Freely Filtered: LIBERATE-D Trial — NephJC podcast on the JAMA trial examining conservative dialysis for AKI and kidney function recovery.

Here is today's #eyeSCANdy! Scanning EM of a normal glomerulus showing a glomerular capillary loop with interdigitating podocyte foot processes. Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

— Arkana Labs (@arkanalabs.bsky.social) 2026-03-11T13:03:53.073601Z

Here is today's #eyeSCANdy! Urine – calcium oxalate crystals Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

— Arkana Labs (@arkanalabs.bsky.social) 2026-04-10T13:04:09.973945Z

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Reading:

• Process Knowledge by Cory Doctorow — Why the tacit expertise held by workers matters more than intellectual property, and why it is systematically undervalued.

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• After 20 years, kidneynotes.com is now responsive to screen size and 3,000+ posts are now tagged.

The PREVENT Calculator and Albuminuria: Normal is Not Normal

The PREVENT Calculator shows how 10-year ASCVD risk can change dramatically even with a urine albumin level in the "normal" range. Compare a urine albumin of 0 with a urine albumin of 29:

Saturday Evening

Epic EMR Tips: "Trend eGFR"

Did you know that if you type "trend eGFR" in Epic's search bar, you get this? 

NephMadness 2026, an eGFRcr-cys Oddity, Epic Health Alerts, and Battery Tracking

Nephro:

• NephMadness 2026 — Year 14 of the nephrology bracket tournament!
• A peculiarity of the eGFRcr-cys equation is that the eGFR is sometimes HIGHER than the eGFRcr and eGFRcys equations individually.

An updated eGFR Percentile Explorer App. egfr-percentile-explorer.netlify.app

— Joshua Schwimmer, MD (@joshuaschwimmer.bsky.social)
[link]

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Tools:

• Epic Health Alerts — Epic's new public health alert system.
• Juicy — Beautiful Mac battery alerts and health monitoring.

An Updated eGFR Percentile Explorer App

This eGFR Percentile Explorer is gratefully built on the work of Antoine Créon and the Stockholm Creatinine Measurements Project. (This modified work is released under the GNU Affero General Public License v3.0 (AGPL-3.0), consistent with the license of the original work.)

Attie AI, Laura Cannell, Loscil, and a Spotify Mix

Tools:

• Attie — A personalized feed built on the AT Protocol. Describe what matters to you in plain language and it reshapes itself.

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Music:

AURORAE by Laura Cannell — Baroque violin and recorder, haunted and beautiful.

The Medieval Drone Society II by Laura Cannell — More drone and early music. Good pairing with AURORAE.

Sea Island by Loscil — Ambient electronics. Dense, patient, immersive.

Spotify Daily Mix — Today's algorithmic offering.

Meditation Apps, Habit Streaks, an IgAN Calculator, and Piano for the Office

Apps:

• The Way — Guided Zen meditation.
• Waking Up — Theory and practice of meditation.
• Streaks — Track up to 24 daily habits.

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Nephro:

Useful for IgAN therapy: A calculator to estimate 24-hour urine protein from a spot protein-to-creatinine ratio. www.kidneynotes.com/2026/04/a-ca...

— Joshua Schwimmer, MD (@joshuaschwimmer.bsky.social)
[link]

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Office Music:

• Piano in the Background — Spotify playlist.

A Calculator to Estimate the 24-Hour Urine Protein from a Spot Urine Protein-to-Creatinine Ratio

24h Protein Estimator

Estimates 24-hour urine protein from spot UPCR using the validated multivariate Chen 2019 equation.

Chen et al. PLoS ONE 2019;14(4):e0214614

Clinical caveat: Validated for proteinuria <3 g/day. Agreement with measured 24h UP weakens above this threshold (Bland-Altman). For suspected nephrotic-range disease, a timed 24h collection remains the reference standard.

Patient Inputs

Spot UPCR mg/mg

mg/mg

Urine protein (mg/dL) ÷ Urine creatinine (mg/dL)

Body Weight kg

kg

Age years

yr

Sex at Birth

Male = 1, Female = 0 per published equation

CKD Stage

eGFR (mL/min/1.73m²) shown. G3a selected as default.

Please fill in all fields.

Estimated 24-Hour Urine Protein

— g / day

—

log₁₀(24hUP)

—

UPCR Input

—

log₁₀(UPCR)

—

CKD Stage Coeff

—

Proteinuria Severity — KDIGO Categories

00.150.51.03.5>3.5 g

Equation Reference

log₁₀(24hUP [g]) = 0.814 × log₁₀(UPCR) + 0.110 × Gender − 0.004 × Age + 0.004 × Weight(kg) + 0.002 × CKD coeff − 0.018

Variable	Coefficient	Encoding
log₁₀(UPCR)	0.814	UPCR in mg/mg
Gender	+0.110	Male = 1, Female = 0
Age	−0.004	years
Weight	+0.004	kg
CKD Stage Coeff	+0.002	G1=1, G2=2, G3a=3.1, G3b=3.2, G4=4, G5=5
Intercept	−0.018	—

Validation: Derivation cohort r = 0.866; Validation cohort r = 0.915. R² = 0.80 vs. 0.67 for unadjusted UPCR. Validated in 1,120 CKD patients, Chang Gung Memorial Hospital, Taiwan (PLoS ONE 2019).

For clinical decision support only. This calculator aids clinical judgment and does not replace physician assessment or timed urine collections. Not validated for AKI, pregnancy-related proteinuria, or dialysis patients.

Reading Apps, Calendar Upgrades, a BP Tracker, and the Case for Resilience

Apps:

• Readwise Reader — Read-later app that syncs highlights from Kindle, articles, PDFs, and RSS feeds.
• Fantastical — The best calendar app on Apple platforms. Natural language event creation.
• RANDOM.ORG — True random number generator. Uses atmospheric noise.
• Countdown — Pretty progress bars for upcoming events and deadlines.

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Projects:

• Blood Pressure App — A guide to checking blood pressure.

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Reading:

• The Healing Power of Resilience by Dr. Tara Narula.

Clipboard Managers, Timers, Hydration Tracking, Mac Automation, and Kali Malone

Apps:

• Paste — Clipboard manager for Mac, iPhone, and iPad. Keeps everything you copy searchable and synced.
• Timer+ — Multiple simultaneous timers and stopwatches.
• WaterMinder — Water intake tracking with Apple Health sync.
• Keyboard Maestro — The Mac automation tool. If you can describe it, you can automate it.

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Now Playing:

Music for Intersecting Planes by Kali Malone & Leila Bordreuil — drone and cello.

eGFR Tools, Cognitive Labor, Blindsight Revisited, and Jazz for Reading

Tools:

• NIDDK's Calculators — We are particular about eGFRcr-cys calculators.
• eGFR Percentile Explorer — Visualize population-based eGFR distributions by age, sex, and estimating equation.

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Reading:

• The Displacement of Cognitive Labor and What Comes After — Sahaj Garg on AI surpassing human cognitive capabilities and what happens to knowledge work.

• Did I really read Blindsight by Peter Watts in 2007 and forget about it completely? And then reread it in 2026?

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Office Music:

• Jazz for Reading — Spotify's jazz piano playlist.

Voice Apps, Smart Calendars, Flea's New Album, and a Surgeon's AI Morning Routine

Apps:

• Speechify — Text-to-speech for Kindle books, PDFs, and web articles.
• Wispr Flow — AI voice dictation that works in any app. Mac, Windows, iPhone, Android.
• For all its quirks, Reclaim.AI is still the best smart calendar app I've found.

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Now Playing:

Honora by Flea — new solo album, out this week.

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Reading:

• Warren Ellis Reviews Project Hail Mary — On the film adaptation of Andy Weir's novel.
• How Dr. Christian Pean Uses Claude Cowork Before Breakfast — An orthopedic surgeon's AI morning workflow.

Three Apps, a Tip, and the NephJC Kidneys Awards

📱 Apps:

	Jomo — screen time blocker
	Routinery — routine planner, habit tracker
	StressWatch — AI stress monitor

• iOS tip: you can jump straight to your App Store updates page by bookmarking itms-apps://apps.apple.com/updates. Bypasses the front page, which I never want to see.
• AI and Medicine: Your Secret to Better Health — MasterClass with Dr. Suchi Saria, Raj Manrai, and Dr. Adam Rodman
• The 2026 NephJC Kidneys Award Winners

odds and ends

• ACME Weather — from the creators of Dark Sky
• Relaxing Piano Jazz — office playlist
• Morning music.

Link blogging is new again: KidneyNotes.com

— Joshua Schwimmer, MD (@joshuaschwimmer.bsky.social) 2026-03-27T22:16:29.751Z

Nephro Rounds

• PREVENT Calculator
• MGRS Calculator
• Epic EMR tip: use keyboard shortcuts. Alt-A could save you an hour a week.

A KDIGO commentary on B Cell and Complement guided therapy in IgAN www.kidney-international.org/article/S008... in Kidney Int Perfectly timed for #NephMadness (and this will be the champion)

— Swapnil Hiremath 🍁🇨🇦 (@hswapnil.medsky.social) 2026-03-26T09:19:01.296Z

Here is today's #eyeSCANdy! Scanning EM of a normal glomerulus showing a glomerular capillary loop with interdigitating podocyte foot processes. Photo courtesy of Dr. Stephen Bonsib. #renal #pathology #kidneypath

— Arkana Labs (@arkanalabs.bsky.social) 2026-03-25T13:03:16.071396Z

26Mar26

• ♪ This week's office music: Jazz for Study
  
• Troubadour Apex 4.0 Backpack — Best work bag I've ever had. Great on the subways. Multiple surprising and undocumented features.
• Gemini, when it makes an error, resembles Marvin the Paranoid Android.
• Biological War: A Scenario — Annie Jacobsen
• Current Reader App — RSS reader by Jupiter Interactive Group LLC. $9.99.
• Bevel: All-In-One Health App — Favorite all-in-one health app. Covers exercise, sleep, and nutrition — iPhone and Apple Watch.

Background music for seeing patients this week.

Brain.FM.

Local hero wins at football and CKD

Dr. Joel Topf: 

With the stroke of a pen, his wait time moved from late 2021 to early 2018. An additional three years. This was enough to thrust him near to the top of the list. In September of 2024, Norris got his kidney and three days later he was home with a falling creatinine, feeling better than he had in years. A lot of people worked hard to remove race from eGFR equations. It can feel like an abstract policy debate. But sometimes it looks like this.

This Week's Background Music While Seeing Patients

Nephrogram.com

Nephrogram.com is live in time for Kidney Week: real-time, high-impact nephrology updates expertly curated by dozens of AI agents. Enjoy.

A quicker way to estimate the eGFR of CKD-EPIcr-cys.

Estimating kidney function by calculating the estimated glomerular filtration rate (eGFR) is important, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-cystatin C equation (CKD-EPIcr-cys) is one of the most accurate ways of estimating eGFR. However, after reviewing thousands of laboratory tests from institutions nationwide, I've seen only ONE lab automatically calculate the eGFR using CKD-EPIcr-cys.

Instead, labs typically calculate eGFR using either the CKD-EPI creatinine equation (CKD-EPIcr) based on serum creatinine or the CKD-EPI cystatin C equation (CKD-EPIcys) based on serum cystatin C. But if you want the more accurate CKD-EPIcr-cys? You're on your own, and you must calculate CKD-EPIcr-cys using a website like the National Kidney Foundation.

A more practical and quicker method to estimate the eGFR of CKD-EPIcr-cys is to average the eGFR values obtained from CKD-EPIcr and CKD-EPIcys. This method is almost as accurate and significantly faster.

Consider an 81-year-old man with a serum creatinine level of 1.6 mg/dL and a serum cystatin C level of 2.2 mg/L.

Using the equations from the NKF website:

• Using CKD-EPIcr: eGFR = 43 mL/min/1.73 m²
• Using CKD-EPIcys: eGFR = 25 mL/min/1.73 m²

The estimated eGFR by averaging these values is (43 + 25) / 2 = 34 mL/min/1.73 m².

For comparison, the calculated eGFR using CKD-EPIcr-cys is approximately 33 mL/min/1.73 m², showing a difference of only 1 mL/min/1.73 m².

In this example, the difference in eGFR was only 1. Using the average eGFR of CKD-EPIcr and CKD-EPIcys -- both printed on most lab tests -- is usually an excellent way to estimate the eGFR of CKD-EPIcr-cys.

You can also create a macro to automate the averaging process, reporting the estimated eGFR in patient charts as "eGFR = X (avg. of CKD-EPIcr & CKD-EPIcys)."

Best Apple AI feature.

“Intelligent Breakthrough & Silencing” is the best feature of Apple Intelligence in iOS 18.1 beta.