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Susan Murray and Matthew A. Sparks

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

Karen Blum

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

Mitchell H. Rosner

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)

Marina Lopez-Martinez and María José Soler

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

Mayuri Trivedi and Kirk N. Campbell

Novel biomarkers have been changing our understanding of glomerular disease physiology by improving our diagnostic and prognostic capabilities while opening the door to more precise therapeutic options. Most notably, the discovery of the anti-phospholipase receptor-2 antibody (anti-PLA2R Ab) in 2009 has facilitated diagnostic algorithms where some patients with high PLA2R titers may not need a kidney biopsy. Titer levels are followed clinically to monitor response to treatment and risk of relapse, whereas novel therapeutics are being developed to specifically inhibit presumed pathogenic properties of PLA2R Abs (1).

Nephrin, an important component of the slit diaphragm, has been one

Karen Blum

Having a positive experience as a patient, achieving good outcomes, and being seen as humans are among the priorities that are most important to patients and should be the centerpiece of diabetes and chronic kidney disease care, according to a presentation at Kidney Week 2021.

Providers know what their priorities are when caring for patients, but it's imperative that they line up with what patients want and feel, said Matt Cavender, MD, MPH, an interventional cardiologist and assistant professor of medicine at the University of North Carolina School of Medicine in Chapel Hill.

A 2021 survey by the Beryl Institute

Jia Hwei Ng

Self-identified race is a complex interplay of social identity, genetic ancestry, and socioeconomic status (1). In the setting of chronic kidney disease (CKD), classifying patients using race purely as a surrogate for genetic ancestry is problematic because social constructs and socioeconomic status play a large role in the development of CKD (2, 3). The use of race adjustment in the estimated glomerular filtration rate (eGFR) equation to determine kidney function has been questioned for several years because the race-based equation underestimates the prevalence and severity of CKD for patients self-identified as African American (

Samira Farouk

Black individuals, who are at a two- to fourfold higher risk of developing end stage kidney disease in the United States, are simultaneously less likely to be referred for transplantation, to be waitlisted, or to receive a kidney transplant (KT) (13).

The murders of countless Black individuals sparked uprisings in 2020 throughout the United States. This included efforts spearheaded by medical students around the country to remove race as a factor in estimated glomerular filtration rate (eGFR) calculation at their institutions (4). Racialized algorithms, which include race in eGFR equations, result in higher values

Bridget M. Kuehn

Patient advocate Dawn Edwards has spent most of the last 30 years on home dialysis, including 10 years on peritoneal dialysis. She has also mentored hundreds of people with kidney disease. So, she is well aware of the burdens and barriers that can stand in the way of a patient starting and staying on home dialysis. The key, she says, is having a good team.

“It's really important for clinical teams and interdisciplinary teams to…work together to provide patients the support and resources they need to be successful at home,” Edwards said.

Edwards was one of a panel of experts

Katie Westin Kwon and Eugene Lin

The past few years have seen a number of for-profit companies seeking to partner with nephrologists to manage their patients with later stage chronic kidney disease (CKD). Kidney disease is an expensive medical condition to treat: Medicare's total cost of care for patients with kidney disease in 2018 was $81.8 billion (1). Both Medicare and private payers have advanced care models that reduce that cost. New value-based care (VBC) initiatives focus on the patient population that is at risk for developing end stage kidney disease (ESKD). These programs will financially reward providers who successfully slow kidney disease progression