The dust is still settling from the election of November 4, 2014, when Republicans gained control of both chambers of Congress. Whether a Republican Congress and a Democratic administration can work together to address the many domestic and foreign challenges confronting the country today is one of the biggest questions as we head into 2015.
One thing most Democrats and Republicans agree on, though, is that medical research is one of the smartest investments the United States can make. Funding for the National Institutes of Health (NIH), the global leader in medical research, creates jobs, drives the economy, and most
Insights from recent research into the nephrology workforce will inform discussions about nephrology’s future in 2015. Researchers from George Washington University (GWU) will continue their collaboration with the American Society of Nephrology (ASN) and expand upon their initial nephrology workforce research. Discussion of workforce trends and developments in the specialty is timely and has become more urgent after results of the Match for appointment year (AY) 2015–2016 were released on December 3, 2014.
Nephrology workforce trends
In February 2014, ASN Council approved 50 initiatives to increase interest in nephrology careers among medical students and residents. Included was an analysis of
Although last fall’s anxiety about the spread of the Ebola epidemic has receded, the outbreak continues in Africa. The possibility that U.S. hospitals will be treating more Ebola virus disease (EVD) cases cannot be discounted, and advance preparation is the key to coping with any infectious disease.
EVD treatment calls for special protocols—one in particular is the need to perform renal replacement therapy (RRT) in a biocontainment room. Several guidelines and resources have already appeared, including a proposal in an article, “Successful Delivery of RRT in Ebola Virus Disease,” in the Journal of the American Society of Nephrology.
Primary glomerular disease is an important cause of chronic and end stage renal disease
Chronic kidney disease (CKD) is increasingly recognized as a growing global challenge, affecting up to 16 percent of the adult population (1,2). Although the veritable explosion in type II diabetes is largely responsible for this growth in developed and many developing countries, primary glomerular disease continues to contribute meaningfully to the CKD epidemic (2). These diseases account for roughly 10 percent of CKD cases in the United States and up to 50 percent in other countries (3,
The therapy of proliferative lupus nephritis (LN) is generally divided into an initial phase of high-intensity immunosuppression to induce prompt clinical improvement, followed by a maintenance phase of lower-intensity immunosuppression to consolidate improvement into remission. Induction most often lasts 3 to 6 months, but maintenance lasts years and often indefinitely. The average duration of maintenance therapy in several recent randomized clinical trials was 3.5 years but ranged beyond 5 years. In fact, one of the most difficult management decisions in the care of LN patients is how long to continue maintenance immunosuppression. The most recent Kidney Disease Improving Global Outcomes
John Sedor, Matthias Kretzler, and Denise L. Taylor-Moon
The main goal of the Nephrotic Syndrome Study Network, NEPTUNE, is to build a translational research infrastructure for diseases manifesting as nephrotic syndrome (NS), which includes focal and segmental glomerulosclerosis (FSGS), minimal change disease (MCD), and membranous nephropathy (MN) (1). The network of investigators from 21 academic centers across the United States and Canada, and two patient interest groups, the NephCure Foundation and the Halpin Foundation, have worked closely together to study these rare glomerular diseases. Despite their rarity, these diseases generate enormous individual, societal, and economic burdens. The current classification of NS fails to capture the molecular
The treatment of idiopathic membranous nephropathy (IMN) has been a matter of discussion for many years. Given the variable clinical course and potential toxicity of current regimens, the main issue nephrologists face at the moment are who to treat and with what regimen. Conservative management is justified for patients with subnephrotic proteinuria, inasmuch as spontaneous remission occurs more frequently in these patients, and their long-term prognosis is usually excellent.
By contrast, patients with nephrotic syndrome (NS) may show a progression to ESRD and are more frequently affected by any of several extrarenal complications. Thus, initiation of specific therapy is indicated
Patients with kidney disease are at increased maternal and fetal risk during pregnancy. In particular, glomerular-based kidney disease is overrepresented among younger patient populations and is therefore a common form of kidney disease that requires management during pregnancy. Potential untoward outcomes include progression of underlying renal dysfunction, worsening of urine protein excretion and hypertension, and untoward fetal outcomes including intrauterine growth restriction and preterm delivery. However, prognostication of an individual woman’s pregnancy-associated risk in the setting of chronic kidney disease (CKD) remains profoundly challenging, especially in the context of glomerular-based kidney disease, wherein there is often a combination of different
In the past several years, major progress has been made in understanding the mechanisms underlying the development and progression of IgA nephropathy (IgAN). These advances have contributed to the generation of an ever-expanding catalog of measurable variables that provide diagnostic or prognostic information about IgAN. Such measures span the gamut from immune mediators and metabolites detectable in serum or urine, to genetic and epigenetic traits, to histologic features both traditional and novel. IgAN has a complex multistep pathogenesis involving essentially every branch of the immune system, and this progress in measurable variables holds great promise for better characterizing the disease
Membranoproliferative glomerulonephritis (MPGN), also termed mesangiocapillary glomerulonephritis, is a diagnosis based on a glomerular injury pattern common to a heterogeneous group of diseases (1). MPGN is characterized by both an inflammatory (proliferative) and resolving (membrane) phase. Histologically, the proliferative phase is characterized by an increase in mesangial and endocapillary cellularity, and the resolving phase is characterized by an increase in mesangial matrix and capillary wall remodeling with basement membrane material forming a wall, resulting in double contour formation.
Previously, MPGN was classified into MPGN types I, II, and III, based on the ultrastructural location of the electron-dense deposits