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In April 2022, the Office of Management and Budget released the annual President's Budget for fiscal year (FY) 2023. The President's Budget is a non-binding request to Congress that describes the priorities of the current administration. In the words of President Biden, “Don't tell me what you value. Show me your budget, and I will tell you what you value.”

The priorities of the current administration are clear. For the Department of Health and Human Services, the budget prioritizes “tackling the COVID-19 pandemic, expanding access to care, addressing health disparities, strengthening behavioral health, and promoting the well-being of children, families,

Insara Jaffer Sathick and Aisha Shaikh

Pseudo-electrolyte disorders are laboratory artifacts, and failure to recognize this entity can lead to inadvertent treatment. The hallmark of pseudo-electrolyte disorders is that the patient does not exhibit classic signs or symptoms of the underlying electrolyte abnormality. This should prompt clinicians to rule out pseudo-electrolyte disorders before initiating therapy. Here, we highlight pseudo-electrolyte disorders seen in onconephrology practice.

Pseudo-hyponatremia

A falsely low sodium level is seen in conditions that reduce the water content of a given volume of plasma, such as 1) severe hyperproteinemia due to paraproteinemia, hypergammaglobulinemia, or intravenous immunoglobulin (IVIG) administration; 2) severe hyperlipidemia due to

Pooja Amarapurkar, Pooja Kalantri, Levard Roberts, and Jose Navarrete

Sickle cell disease and sickle cell trait are associated with several kidney abnormalities. The inner medullary environment of the kidney with low oxygen tension, hyperosmolarity, and acidemia is an ideal setup for hemoglobin polymerization and sickling. Repeated hemolysis, vaso-occlusive episodes, subsequent reperfusion injury, oxidative stress, and inflammation lead to acute and chronic kidney disease (CKD) (1, 2). The various kidney manifestations of sickle cell disease are summarized in Table 1.

Kidney manifestations of sickle cell disease

Glomerular hyperfiltration and lower mean arterial pressure occur in early years of life. With advancing age,

Timothy O’Brien

Chronic hypertension occurs in at least 2% of pregnancies in the United States and is associated with high rates of preeclampsia and other adverse pregnancy outcomes. There is ongoing debate over treatment strategies: Continuing antihypertensive therapy during pregnancy reduces the risk of severe hypertension but has not previously been shown to improve maternal, fetal, or neonatal outcomes.

Findings from a new trial reported in The New England Journal of Medicine suggest that pregnancy outcomes are improved by antihypertensive therapy for women with mild chronic hypertension, with a blood pressure target of less than 140/90 mm Hg.

The Chronic

Jermaine G. Johnston and Elinor C. Mannon

The start of a new year often signals a time for reflection. As we move through 2022, we again may find ourselves asking: What is the state of nephrology research? How are trainees fairing as they build their own independent careers in this field? There are many sources of support that assist trainees at all levels as they hone the skills necessary for scientific investigation. However, this career path is not without challenges, including, but not limited to, scientific investigation funding, time that is dedicated for investigation, support to build a professional network, and the current lack of diversity in

Eric Seaborg

ASN plans to lead the kidney community in reconsidering “every aspect of the future of nephrology” over the next 8 months, ASN President Susan E. Quaggin, MD, said in a March letter to the American Board of Internal Medicine (ABIM) Nephrology Board and the Accreditation Council for Graduate Medical Education (ACGME).

Quaggin was responding to separate messages from the two organizations asking for ASN's input on major revisions of their certification and training program requirements.

In a letter to Quaggin in January, the ABIM Nephrology Board wrote, “For some time the nephrology community has grappled with whether or not certain

Susan E. Quaggin

“Doc, I was told I have stage 5 kidney disease. What happened to stages 1 through 4?”

Almost every nephrologist, including myself, has had this heartbreaking and far too common question asked of them by patients receiving their diagnosis of kidney disease for the first time. Even worse: A patient first learns about kidney function coincident with placement of a catheter to initiate urgent dialysis.

Not surprisingly, these diagnoses trigger a mixture of emotions: fear, anxiety, disbelief … anger. It is time we do better.

The first diagnosis of kidney disease as kidney failure is truly a failure—of the system.

Keisa W. Mathis, Corey L. Reynolds, and Clintoria R. Williams

According to surveys conducted by the Association of Chairs of Departments of Physiology, the percentage of Black faculty has averaged 1% for the past 20 years (1). This same trend in lack of representation exists for the trainee (graduate student and postdoc) level as well, further complicating the recruitment and retention of the next generation of Black physiologists. It was due to these defaults in the system that in the summer of 2020, Black in Physiology (BiP), an organization committed to nurturing and celebrating Black excellence throughout the physiology community, was created by four charter members. Currently, two

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.”

In reality, nephrology has access to the RUC, because the Renal Physicians Association (RPA) is a member of

Koki Abe and Tomokazu Souma

Cell death is a fundamental biological process underlying normal development, homeostasis, and diseases. Regulated cell death is defined as a molecularly controlled cell death that can be modulated (either promoting or preventing) by specific interventions (1). Although apoptosis has been the focus of interest regarding research on regulated cell death and has been historically considered a major cell death pathway in kidney disease processes, there are surprisingly many other ways cells end their lives in a molecularly regulated manner, such as necroptosis, pyroptosis, ferroptosis, and others. Among them, ferroptosis is attracting attention as a critical contributor and a