Detective Nephron, world-renowned for his expert analytic skills, trains budding physician-detectives in the diagnosis and treatment of kidney diseases. L. O. Henle, a budding nephrologist, presents a new case to the master consultant.
What do you have for us today, my dear apprentice?
I have a 77-year-old white woman with a history of type 2 diabetes mellitus and recently diagnosed metastatic ovarian cancer and now acute kidney injury (AKI).
Stop… let’s see what we can dissect from that.
You will be all over this!
Not another onconephrology case, Henle; let’s do some basic nephrology.
The ASN’s Diabetic Kidney Disease Collaborative (DKD-C) has organized a series of three virtual roundtable discussions on the management of diabetic kidney disease to occur this summer and fall. Registration is free and open to all ASN members and partner organizations.
The first session, “Management of Diabetes and Kidney Disease Through COVID-19,” will be held on Tuesday, Aug. 18, from noon to 1:30 p.m. EDT. The discussion will detail the care needs and patient experience managing diabetes and kidney disease during the COVID-19 pandemic, outline frequent patient concerns, and provide strategies for maintaining health. The conversation will touch on population
As a chef and instructor at a culinary school Duane Sunwold knows a lot about food. But when he received a diagnosis of chronic kidney disease (CKD) in 2000, he discovered he still had a lot to learn.
During the first 2 years after his diagnosis, Sunwold gained 60 pounds because of the medications he was taking, and his creatinine level reached 4.9 mg/dL, just shy of the requirement for dialysis. He tried three different nephrologists. Finally, his current doctor recommended that he try a plant-based diet. It wasn’t easy, but within 2 weeks, he began to feel better. And
As a research fellow in the laboratory of Professor David Salant, MB, BCh, at Boston University, Laurence Beck, MD, PhD, spent several frustrating years trying to identify the targets of the autoantibodies that cause idiopathic membranous nephropathy (IMN). Finding these targets was critical to understanding why the immune system attacks the body’s own cells in that disease. Then, in 2009, he and his colleagues identified the M-type phospholipase A2 receptor PLA2R as a prime target (1). At the time, they didn’t know how pivotal their discovery would be.
“When we finally identified PLA2R, that was certainly
The dilemma of how to best manage fluid levels in critically ill patients receiving mechanical ventilation is a familiar one to nephrologists who may frequently encounter this challenge in patients with sepsis. But managing fluid balance in patients with coronavirus disease 2019 (COVID-19) poses a whole new set of challenges.
There is bi-directional crosstalk between the lung and kidney in critically ill patients with acute respiratory distress syndrome (ARDS), said Kathleen Liu, MD, PhD, professor of medicine at the University of California, San Francisco. Patients with COVID-19 frequently experience severe and prolonged ARDS, but whether there are COVID-19–specific pathogenic mechanisms
Among patients with hypertension, previous treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) does not increase the risk of severe or fatal COVID-19, concludes a study in The Journal of the American Medical Association.
The retrospective analysis included data on 4480 patients with COVID-19, median age 54.7 years, drawn from Danish national registries. Patients were followed up from diagnosis until they reached a study outcome, or until early May 2020.
Twenty percent of patients had been using ACEI/ARBs, based on prescription fills within the previous 6 months. The primary outcome was death; secondary outcome was a composite of
Patients receiving dialysis in predominantly black neighborhoods have higher rates of hospitalization, and Black and Hispanic women have higher rates of hypertension after preeclampsia, according to a pair of studies.
The studies are the latest in a growing body of evidence to suggest that substantial disparities in kidney care exist among patients who are Black and Hispanic, and they highlight the need for improved care to reduce preventable complications.
While the studies identify disparities, they fail to explicitly address the role that both structural racism and implicit biases in care may play in causing them, said Vanessa Grubbs, MD, associate
We need your help to secure the $200 million KidneyX Artificial Kidney Prize to address challenges facing people with kidney diseases during the pandemic.
According to Medicare claims data, kidney patients are the most at-risk group among beneficiaries for COVID-19. COVID-19 patients with kidney diseases are 2.5-times more likely to be hospitalized or face other adverse outcomes, including death, from the virus.
Growing evidence suggests that COVID-19 causes kidney injury in patients with otherwise healthy kidney function, further stressing the kidney health system.
COVID-19 has created a new sense of urgency to accelerate the development of an artificial kidney—work that
Infection rates associated with native arteriovenous fistulas (AVFs) are low compared with arteriovenous grafts and tunneled hemodialysis (HD) catheters (1). However, the type of AVF cannulation technique has a significant impact on subsequent infectious complications. The “buttonhole” (BH) or “constant site” AVF cannulation technique refers to the insertion of blunt needles through two developed fibrous tunnels/tracts at consecutive dialysis treatments.
The two alternative AVF cannulation techniques are the “rope-ladder” (RL) technique, which involves using a different site to place two sharp needles during consecutive HD sessions, and the “area” or “cluster” technique, in which sharp needles are placed
In the day-to-day jargon of a nephrologist, the word “adequacy” is unique in its usage in this profession. Whereas the Merriam-Webster definition of “adequate” is “sufficient for a specific need or requirement,” nephrologists use this term to reflect the quality of the dialysis prescription.
Measuring the adequacy of hemodialysis (HD) and peritoneal dialysis (PD) has long been a topic of intense interest and debate. Currently, we measure adequacy using the fractional urea clearance equation known as Kt/V, whereby K is the clearance of urea, t is time during dialysis, and V is volume of distribution of urea.