Hippocrates. Engraving based on drawing by Peter Paul Rubens. National Library of Medicine, Bethesda, MD (CC by 4.0).
Portrait of Richard Bright from Thomas Joseph Pettigrew, Medical Portrait Gallery, vol. 2 (1838).
Nephrology is a relatively young specialty. It emerged in the second half of the 20th century, with the rise of kidney biopsy, dialysis, and transplantation. Although kidneys have been studied since antiquity, stones and obstruction were a dominant focus. Urology books from 1739 mention the only treatment of anuria as bladder catheterization (1). So, how did the study of glomerular diseases rise as a cornerstone of
As a specialty, nephrology is heavily dependent on international medical graduates (IMGs). According to the Association of American Medical Colleges (AAMC) (1), 65% of nephrology fellows in 2019 were IMGs, the highest of any major internal medicine specialty. This has now led to more than one-half of the active workforce being graduates of international medical schools (51%). Although the exact numbers of IMGs on a visa and the proportion of J-1s and H1-Bs are unknown, it is well recognized by local and national leaders that providing viable and satisfying solutions for entry into the workforce for a nephrology
Methotrexate (MTX) has been used for treatment of connective tissue disorders, including rheumatoid arthritis. In much higher doses, MTX is used for various hematologic and oncologic disorders (1). Renal elimination accounts for 70%−90% of the clearance of MTX (2). High-dose intravenous MTX has the potential for causing kidney injury by crystal precipitation within the renal tubules (3, 4). In addition, oral MTX can potentially accumulate in patients with reduced kidney function and lead to toxic effects, such as myelosuppression and hepatotoxicity (5). However, although MTX is contraindicated in patients with
Caitlyn Vlasschaert, Jade M. Teakell, Harish Seethapathy, Shuhan He, and Edgar V. Lerma
Emoji are text-embedded pictograms used to communicate and provide context in written electronic messages. Billions of emoji are sent worldwide every day (1). There currently exist anatomical heart, brain, and lung emoji but no kidney emoji. Chronic kidney disease (CKD) affects 1 in every 10 people (2), yet kidney health literacy is limited in the general population (3) and even in those with CKD (4). The introduction of a kidney emoji would help jumpstart a global conversation about kidney health in the general population. Here are the steps needed to transform this
Brittany Schreiber, Kevin Fowler, and Naoka Murakami
Onco-nephrology is evolving as an important subspecialty in transplant care. Brittany Schreiber (BS), a renal fellow, interviews Kevin Fowler (KF), a kidney transplant recipient, and Naoka Murakami (NM), a transplant nephrologist.
BS: Why are you interested in onco-nephrology?
KF: I received a preemptive kidney transplant in 2004, and due to chronic immunosuppression, I have had several episodes of cancer. Fortunately, all of the episodes were successfully resolved, but the pathway to treatment success has not always been clear. For example, when I was diagnosed with prostate cancer, I had to navigate a landscape where I felt alone. I received
A nationwide data analysis confirms that SARS-CoV-2 antibody responses to vaccination decrease rapidly in dialysis patients, leaving them at risk of breakthrough infection, reports Annals of Internal Medicine.
The researchers analyzed real-world data on 4791 patients receiving care in a large US network of dialysis facilities. Residual plasma from routine monthly tests performed at a central laboratory was used to measure qualitative and quantitative antibodies to the SARS-CoV-2 receptor-binding domain (RBD). The analysis began in January 2021, before COVID-19 vaccines were widely available. By mid-September 2021, 2563 patients were fully vaccinated.
Trends in antibody levels were assessed, including the
Immunoglobulin A nephropathy (IgAN) is the most common glomerular disease worldwide (1). The prevalence varies geographically, and estimates of disease burden depend on the registry data assessed. The pathophysiology of this condition includes circulating and glomerular immune complexes comprised of galactose-deficient IgA1, an IgG autoantibody (directed against the hinge region O-glycan), and C3 (1). Experimental models suggest that environmental factors can trigger aberrant IgA production in highly active sites such as the mucosal-associated lymphoid tissue (MALT) in the gastrointestinal tract, which ultimately leads to immune complex deposition in key compartments of the kidney. Mesangial cells serve
Even after decades of follow-up, kidneys transplanted after circulatory determination of death (DCD) show similar outcomes to kidneys donated after brain death (DBD), reports a study in Nephrology Dialysis Transplantation.
Of 1133 kidney transplants performed between 1985 and 2000 at the authors’ Swiss medical center, 122 used DCD grafts. The DCD kidney recipients—74 men and 48 women, median age 46 years—were matched one to one for sex, age, and transplant year to patients receiving DBD grafts during the same period. Outcomes were assessed through 2020.
At 35 years’ follow-up, median graft survival was almost identical between groups: 24.5
For older adults with type 2 diabetes, treatment with a sodium glucose cotransporter-2 inhibitor (SGLT2i) is associated with a lower risk of acute kidney injury (AKI), compared with other antidiabetic medications, according to a pre-proof paper in the American Journal of Kidney Diseases.
The population-based cohort study used Medicare fee-for-service data on more than 417,000 patients, aged 66 years or older, with type 2 diabetes. All enrolled patients had a newly filled prescription for an SGLT2i, a dipeptidyl peptidase 4 inhibitor (DPP-4i), or a glucagon-like peptide-1 receptor agonist (GLP-1RA) from 2013 through 2017. New SGLT2i users were propensity
The nomenclature shift from contrast-induced to contrast-associated acute kidney injury (CA-AKI) reflects a waning confidence in the nephrotoxicity of iodinated contrast. Despite early animal and observational data supporting this nephrotoxicity (1, 2), more appropriately controlled and matched studies have failed to demonstrate this link (3–6). In 2004, Mehran and colleagues (7) developed a risk score to predict CA-AKI in people undergoing percutaneous coronary intervention (PCI). In a recent study published in The Lancet(8), the investigators aimed to update this risk score to reflect more contemporary clinical practices.