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.
Dr. Charuhas V. Thakar hits the target squarely in his June 2022 article, Essential versus Necessary: The Ongoing Story of Physician Burnout (1): “This paradigm of care delivery is simply not sustainable.”
His critique of the current relative value unit (RVU) treadmill that is the “traditional business plan” is couched in terms of physician burnout. Let me change the perspective: It amounts to patient abandonment. Despite billions of federal and insurer dollars poured into kidney care, more than 134,000 Americans entered end stage kidney disease (ESKD) in 2019. Is that success? Is that good return on investment?
Recognizing the ongoing challenges affecting health care workers nationwide, leading to burnout and moral distress, the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience has devised the National Plan for health workforce well-being.
“It is critical for us to have a coordinated plan at the national level to help shift US health care from the current reality of a workforce shortage and burnout crisis to a future where every health worker is able to experience joy in their workplace and knows that they are valued,” said NAM President Victor Dzau, MD, in a prepared statement. The
Thrombotic microangiopathy (TMA) is a clinicopathological entity characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury, occurring due to endothelial damage and microthrombi formation in small vessels (1, 2). It can affect up to 15% of transplanted patients and is associated with significant morbidity and mortality (3).
TMA is primary when a genetic or acquired defect is identified (as in atypical hemolytic uremic syndrome [aHUS] and thrombotic thrombocytopenic purpura) or secondary when occurring in the context of another disease process, such as infection, autoimmune disease, malignancy, or drugs (4) (Table 1
Infection remains a major cause of morbidity and mortality in dialysis and kidney transplantation. Despite dramatic improvements over the last 3 decades, peritoneal dialysis (PD)-associated peritonitis remains a common complication, occurring at an incidence of approximately 0.25 episodes per patient-year, and is the leading cause of technique failure with catheter removal, the eventual outcome in approximately 20% of infectious episodes (1). The causative agents of peritonitis are generally skin organisms introduced into the system by “touch contamination” or enteric organisms entering the glucose-rich dialysate via translocation.
Early diagnosis and prompt administration of antibiotics improve the clinical outcome and
The ASN Task Force on the Future of Nephrology was established in April 2022 to evaluate the specialty and develop a recommendation to ensure nephrologists are best prepared to provide care to people with kidney diseases. The ASN task force (see box) has been meeting weekly to discuss core and evolving elements of nephrology that must be considered in future training requirements. Additionally, the task force has hosted a series of listening sessions with various constituencies or partner organizations to understand the changing needs of the community as well as the evolution of medical education.
The House Appropriations Committee on Labor, Health and Human Services, Education, and Related Agencies released its draft funding bill for fiscal year (FY) 2023 on June 22. The report language in the bill bolsters the nation's public health infrastructure and strengthens biomedical research and innovation. The bill allocates funding for and directions to agencies and programs on policy priorities for which ASN and the broader kidney health community have advocated. Key policies are highlighted here.
Centers for Disease Control and Prevention (CDC)
The committee includes a total of $10.5 billion for the CDC, which is $2 billion more than the