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Mark Lukaszewski

In 2014, Congress made major gains toward finally repealing the broken sustainable growth rate (SGR). But, as of press time, Congress had failed to get legislation to repeal SGR over the line, meaning that physicians will again face pay cuts—and the hope of repeal—in 2015.

What is SGR?

In an attempt to control Medicare spending on physicians’ fees, Congress enacted the SGR formula in 1997. Although it has called for dramatic reductions in payments over the past decade, each year Congress has temporarily overridden the cuts and kept the SGR in place. According to the formula, if no changes are

Suppose you’re seeing a new patient with kidney disease, high blood pressure, and high cholesterol. What if you could order a single lab test that would assess all known gene variants that might affect his response to common drugs—not just medications he’s currently taking, but also common drugs that may be prescribed in the future? That’s the approach being studied by The University of Chicago’s Center for Personalized Therapeutics and other centers nationwide.

The goal is to develop a “medical system model” to overcome barriers to personalized medicine, incorporating patient-specific pharmacogenomic results into everyday patient consultations. The model is being

Grant Olan

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

Kurtis Pivert

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

Eric Seaborg

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.

Richard A. Lafayette
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,

Brad H. Rovin and Samir V. Parikh

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

Claudio Ponticelli

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

Ayodele Odutayo and Michelle Hladunewich

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