This article has been updated to include the following Correction:
The February Kidney News article “A Call to Action for Physicians: Become Informed and Empowered, and Begin to Heal Thyself” includes the statement, “The RUC [American Medical Association (AMA) Relative Value Update Committee] is a group of 32 physicians and other health care professionals who advise CMS [Centers for Medicare & Medicaid Services] on how to value various medical services. The advice of the RUC is nearly always accepted by CMS, yet nephrology is not currently represented on the committee.”
The nephrology community was abuzz at ASN Kidney Week 2021 as Rajiv Agarwal presented the results of the Chlorthalidone in Chronic Kidney Disease (CLICK) trial, with simultaneous publication in The New England Journal of Medicine(1).
In an attempt to refute the dogma that thiazide-like diuretics lose effectiveness at low estimated glomerular filtration rate (eGFR) (2), the CLICK trial enrolled 160 patients with stage 4 chronic kidney disease (CKD; eGFR 15 to >30 mL/min/1.73 m2) and uncontrolled hypertension—defined as a mean
For patients with advanced chronic kidney disease (CKD), early dialysis initiation—at an estimated glomerular filtration rate (eGFR) of 15–16 mL/min/1.73 m2—leads to modest reductions in mortality and cardiovascular events, reports a study in The BMJ(1).
“However, to reach the maximum survival benefit, patients would need to start dialysis up to 4 years earlier,” comments lead author Edouard Fu, PhD, a research fellow at the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
The conclusions are consistent with the sole previous randomized trial of dialysis initiation times—and support
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