Last year, ASN President Susan E. Quaggin, MD, FASN, and I alternated sending monthly email updates to ASN members. Drafting these updates helped us put individual activities—such as the society's commitment to justice, equity, diversity, and inclusion—into a broader context. This year, we’re excited to publish these updates as editorials in ASN Kidney News.
2022 marks Dr. Quaggin's 33rd year as a member of ASN. “Over this period, it has been amazing to witness the growth and impact of our programs, which are driving innovation and positive changes in education, research, and patient care,” she told me recently.
The COVID-19 pandemic and kidney involvement constitute an evolving story with various twists and turns, and we expect new challenges as we enter the third year of the pandemic. In spring and summer of 2020, COVID-19-associated acute kidney injury (AKI) was one of the biggest challenges in hospitals, as physicians and staff dealt with a surge of COVID-19 patients on the wards and in the intensive care units (ICUs). The incidence of COVID-19-associated AKI in ICUs ranged from 61% to 76% in the United States, with approximately 30% of ICU patients needing kidney replacement therapy (KRT) (1). Patients
Diabetic kidney disease (DKD) has been in the forefront of industry publications during these challenging yet exciting times. With the advent of recognition of sodium glucose co-transporter 2 (SGLT2) inhibitors and their particular outcome benefits in patients with type 2 diabetes who are particularly prone to developing complications related to cardiovascular (CV) disease, there has been revitalization of our understanding of the mineralocorticoid receptor and the central role it plays in inflammation and fibrosis involving the kidneys.
A nonsteroidal mineralocorticoid antagonist—finerenone—was highlighted in several major randomized controlled trials (1, 2) that enrolled adult patients with chronic
The flurry of kidney-related policies continues unabated, and 2022 brings to the fore another set of policy challenges and opportunities (Figure 1).
Policies to Watch in 2022
A new eGFR equation
In 2020, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) established a joint task force aimed at addressing the use of race in the estimated glomerular filtration rate (eGFR). In a highly anticipated recommendation, the task force published alternatives to using race, a social construct, in eGFR. The task force also tackled challenges for the nephrology community moving forward (1
Medical education, like medicine itself, has evolved over time—from the days of professional guilds and apprenticeships to the establishment of structured postgraduate residency training to duty-hours’ restrictions, changes in licensing exams, and the growth of innovative educational resources (1). As the design of medical training changes, so too does the type of physician it produces. After all, medical education is not simply the acquisition of knowledge or even of skills and experiences but a process of shaping and the metamorphosis of the learner.
In a field like medicine, interwoven as it is with the science and humanity of
The knowledge and understanding of hypertension (HTN) have always been cornerstones of nephrology, and over the last 3 decades, nephrologists have emerged at the forefront of HTN management. As we look back over the last few years, several major trials and findings have emerged, leading to some changes in our ways of thinking and practice. I’ll highlight the top 10 major findings and studies that are making an impact in HTN management. In 2022, we need to continue to take ownership of HTN as nephrologists.
10. Managing hyperkalemia when using anti-HTN agents. Chronic kidney disease (CKD) and HTN
Drugs that are derived from nature are prevalent in nephrology. For example, the first angiotensin-converting enzyme inhibitor (captopril) was isolated from the venom of the Brazilian pit viper, Bothrops jararaca (1). Interestingly, the first sodium glucose co-transporter (SGLT) inhibitor (phlorizin) was isolated from the bark of the apple tree (2). What else does nature have in store?
An unlikely place to look is the saliva of Heloderma suspectum, better known as the Gila monster. This is a venomous lizard native to the United States and Mexico. It turns out that the Gila monster only
Preparing nephrology fellows for current workflows and incorporating advanced practice providers (APPs) and international medical school graduates into nephrology practices are ways to augment nephrology services to meet patient needs during a challenging time, a panel of experts said during Kidney Week 2021. This could also help bridge the current time period where some older nephrologists are looking to retire, and there is a shortage of newer trainees in the field, they said.
“The goal of nephrology training is to ensure fellows are well equipped to take on the care of a diverse patient population, while adapting to the ever-changing
The past decade has seen a revolution in the treatment of patients with cancer with novel therapies that harness the power of the immune system to kill tumor cells (1). This has been achieved by removing checkpoints on the immune system that typically are exploited by tumor cells that allow for proliferation and growth. Two classes of immune checkpoint inhibitors are available: drugs that act against checkpoint proteins programmed death 1 (PD-1) or cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) or both (2). An expected side effect of these drugs is the occurrence of immune-related adverse events (irAEs)
Endothelin-1 (ET-1) plays a role in chronic kidney disease (CKD) progression (1). In the kidney, ET-1 binding of the endothelin A (ETA) receptor drives afferent arteriole vasoconstriction, cell proliferation, podocyte and glycocalyx damage, matrix accumulation, and proinflammatory effects, whereas binding of the endothelin B (ETB) receptor produces vasodilation, antifibrotic effects, and decreased sodium reabsorption and natriuresis (1, 2). Although renin-angiotensin-aldosterone system (RAAS) inhibition has proven a reduction of albuminuria and a proportional effect on kidney protection (3, 4), residual albuminuria still implies a significant risk of CKD progression (5