The number of patients requiring nephrology subspecialty care has grown tremendously. Unfortunately, while fellowship applicants have increased nearly 10% since 2019, nephrology has only had an increase of about 3% (1). This gap between workload and workforce has led to an increase in the use of non-physician practitioners (NPPs), the Centers for Medicare & Medicaid Services’ term that includes nurse practitioners (NPs) and physician assistants (PAs). Within our specialty, however, there has not been adequate discussion regarding proper utilization of NPPs.
While physicians understand their own personal background, they may not understand the wide range of experiences of
As we move into the second half of 2022, almost 29 months since a pandemic changed the world, the time to reflect on how nephrology and our field have evolved seems fitting. My pledge to run 850 miles each year to raise awareness for the 850 million people living with kidney diseases provides me ample time for reflection. This weekend, as I hit mile 3, a single word formed in my mind—courage. This word defines our approach to one of the most complex—and rewarding—areas in medicine.
Courage has many definitions. The one I like the best is “mental and moral
Can targeting the cathepsin C (CatC) in proteinase-3 (PR3)-anti-neutrophil cytoplasmic antibody (ANCA) vasculitis prevent the inflammatory injury associated with ANCA-associated vasculitis (AAV) (1)? Recognizing that neutrophils from individuals with a loss-of-function mutation in a non-serine protease—CatC—maintain bactericidal activity but have limited ANCA reactivity, the authors of a recent study propose pharmacologic inhibition of CatC as a therapeutic target for anti-PR3 antibody (anti-PR3 Ab) AAV (1).
Genetic CatC deficiency is associated with the autosomal recessive condition known as Papillon-Lefèvre syndrome (PLS). After previously noting that mice with CatC deficiency were protected from AAV, the authors designed a
In patients with hemodialysis-dependent kidney failure, treatment with the macrolide antibiotic azithromycin is associated with an increased risk of sudden cardiac death (SCD), reports a preproof paper in Kidney International.
Using data from the US Renal Data System, the researchers performed a cohort study to assess the cardiac safety of azithromycin compared with amoxicillin-based antibiotics in patients on hemodialysis from 2007 through 2017. A separate cohort study compared azithromycin with levofloxacin, a fluoroquinolone antibiotic that, like azithromycin, is known to prolong the QT interval.
The two studies included 381,306 treatment episodes with azithromycin versus 344,125 with amoxicillin-based antibiotics
In the United States, approximately 40,000 new patients are added to the waitlist for kidney transplantation each year, yet in 2021, only 19,000 on the waitlist received deceased donor kidney transplants (1). Because of the burdens of dialysis and the kidney shortage, nearly 8000 waitlisted patients died or became too sick to receive a transplant in 2021 (1). From 2010 through 2020, 18%–21% of procured kidneys were not transplanted, and kidney discards are on the rise (2). In 2021 alone, a total of 5080 kidneys were procured and then discarded. A minority of donor
Frank Hullekes, Rucháma Verhoeff, Paolo Cravedi, and Leonardo V. Riella
Focal segmental glomerulosclerosis (FSGS) recurrence post-transplantation represents one of the most challenging conditions causing kidney allograft failure. Despite intensive research over the past decades, many gaps remain in understanding its pathophysiology. Herein, we review several questions highlighting recent advancements and their potential use in clinical practice.
Are there any reliable predictors of FSGS recurrence?
FSGS is not a specific disease entity but a histopathological “pattern of injury” seen on light microscopy that primarily targets podocytes. Multiple underlying etiologies that lead to podocyte loss have been identified, including systemic, genetic, and medication induced and those mediated by adaptive kidney responses (
Elhussein A. E. Elhassan, Kane Collins, Edmund Gilbert, and Peter J. Conlon
The importance of genomic mismatch between donor and recipient in organ transplantation has been appreciated since Dr. Joseph E. Murray undertook the first successful kidney transplantation in 1954 (1). This seminal event confirmed the critical role that genetics plays in transplant outcome. Subsequent studies demonstrated the importance of genetically inherited human leukocyte antigen (HLA) mismatch between donor and recipient. To guide decision-making in living donors, genomics functions as an additional toolkit to determine susceptibility of a specific inherited disease aggregating among families or specific ancestries, such as apolipoprotein L1 (APOL1) nephropathy.
The recent rulings from the conservative majority on the Supreme Court are being felt in every corner of American life—including the kidney space.
A June 21 ruling “…laid out a roadmap for insurers to shift the costs of end-stage renal disease to Medicare,” according to judicial analyst Ronald Mann writing for the Supreme Court-tracking website SCOTUSblog (1).
A statement from the National Kidney Foundation (NKF) stated the organization was “deeply disturbed” by the ruling (2) as was Kidney Care Partners, which was “deeply disappointed” and vowed to have Congress overturn the ruling (3).
As featured in the July edition of Kidney News, this issue again highlights advances in kidney transplantation. The July issue included articles on the new kidney transplant allocation system, updates from the apolipoprotein L1 (APOL1) Long-term Kidney Transplantation Outcomes (APOLLO) study, recent groundbreaking advances in xenotransplantation, racial inequities and measures to address them, and a review of the increasingly encountered challenge of oxalosis in kidney transplantation. We now turn our attention to genomics, biomarkers, new insights into thrombotic microangiopathy (TMA), focal segmental glomerulosclerosis recurrence in transplantation, and finally, updates on the use of belatacept.