Popularized by cutting-edge research, on the wards, and even on social media, point-of-care ultrasound, or “POCUS,” has the potential to change the way we practice medicine. Widely implemented in numerous clinical settings, current ultrasound devices are made to be compact and affordable, and an argument could be made that POCUS should be incorporated into the routine physical exam. Although many specialties of medicine have adopted this tool for everyday practice, it remains absent, underused, or undertaught in many nephrology training programs and practices. In addition, per the 2017 ASN workforce fellow data, 44% of respondents felt their programs lacked ultrasound
Our favorite time of the year is fellowship interview season. Mornings and afternoons spent with talented, young physicians who exhibit unbridled enthusiasm for our specialty. For most nephrologists, that passion never wanes. The future of our specialty depends upon recruiting, teaching, and mentoring exceptional and diverse trainees. Nephrology is uniquely diverse on every possible level, which makes every aspect of the specialty richer and more fulfilling.
We are proud that our specialty can boast a higher proportion of traditionally underrepresented-in-medicine (URiM) trainees compared to our internal medicine counterparts in cardiology, gastroenterology, pulmonary and critical care, hematology/oncology, and rheumatology (1
Biochemical and microscopic examination of the urine is routinely utilized in the evaluation of patients with kidney disorders, and urine microscopy—by providing a view into what's happening in the kidneys—may at times be a surrogate for histologic testing and serve as a “liquid biopsy.”
Several studies have highlighted the benefits of urine microscopy. In patients with a high pretest probability of acute tubular necrosis (ATN), detection of granular casts or renal tubular epithelial cells (RTECs) has a very high positive predictive value and low negative predictive value (1). Application of a urinary sediment score (composite of number of
Anika Lucas, Mala Sachdeva, Ellie Kelepouris, and Lisa M. Curtis
Over 60 years ago, nephrology was established as a medical specialty. In 1966, the American Society of Nephrology (ASN) was founded by 17 men (1). Although there were many notable women researchers and physicians caring for women with kidney disease at that time, there was an apparent gender gap in leadership. Interestingly, women were trailblazers in the field of nephrology even before it was recognized as a distinct specialty. Women such as Phyllis Adele Bott, Margaret Mylle, Muriel MacDowell, and Dr. Alma Elizabeth Hiller made profound contributions to our understanding of renal physiology (2). Pauline M.
Nadia McLean, Shina Menon, and Stuart L. Goldstein
The call was one received ever so often, for this fledgling nephrology service on the small island: A newborn with no urine output and a startlingly high blood urea nitrogen and creatinine. He had become edematous and would soon need a ventilator. There was no antenatal ultrasound, as is the norm in these rural parts. A few calls are made to the capital: their wards are full. “It's you and me, baby” is the thought that runs through the young nephrologist's head as she makes her way to the hospital neonatal ICU. What are her options? She recalls similar discussions
The success of Wikipedia, Airbnb, and Uber and the increasing influence of social media show the strength of decentralizing knowledge, the power of collaboration, and the ways we find community in modern times (1). Despite the rise of this “sharing economy,” in the United States and Canada, healthcare systems remain areas of centralized power and expertise. Pediatric nephrology, fortunately, has shown to be a field amenable to collaboration at all levels, and the last year has increased the opportunities for this work.
Former US Surgeon General C. Everett Koop once said, “Drugs don't work in patients who do
There are five reasons why I'm a pediatric nephrologist, but they might not all be the reasons you'd think. After all, my renal block in medical school was certainly not my favorite, and my clinical nephrology exposure was limited. I heard the stories—“To be a nephrologist, you have to be the smartest doctor in the hospital.”—and since I never saw myself as “the smartest,” I didn't think the field was for me. But by the end of my month on pediatric nephrology as a first-year resident, a confluence of inspiring events and the encouragement of supportive mentors had changed my
Michelle Starr, Tahagod Mohamed, Katherine Twombley, and Keia Sanderson
Kidney disease in premature infants and critically ill neonates is a growing problem. One in 10 children is born prematurely each year (1). In these neonates, improvements in neonatal intensive care have increased survival and shifted focus to long-term outcomes. Kidney-related outcomes are increasingly recognized in this population (2). Children born prematurely have a 3-fold increased risk of chronic kidney disease (CKD) and a 1.5-fold increased risk of end-stage kidney disease over the life course compared to children born full term (2, 3). This clinical problem will continue to grow as more
Although the number of children with end-stage kidney disease (ESKD) is small compared to adults, their management can pose a unique challenge due to variability in size and their complex medical, growth, and maturational needs, as well as caregiver involvement. The adjusted incidence of ESKD in children has remained relatively unchanged from 2014 to 2018, ~11.5 per million population, whereas prevalence has increased, with close to 71% of the pediatric ESKD population receiving kidney transplant (1). Racial disparities are noted in modality of treatment, with White children twice as likely to receive a kidney transplant as Black children,
How many times were you consulted on or followed up on a child with cancer with one of the following issues: hypertension, acute kidney injury, proteinuria, hematuria, fluid and electrolyte imbalances, tumor lysis syndrome, kidney and urinary tract infections, kidney tumor, on nephrotoxic medications, stem cell or bone marrow transplant, thrombotic microangiopathy, or chronic kidney disease (CKD)? All the time, right? With advances in cancer therapies and development of novel treatments like CD19-targeted chimeric antigen receptor T cell (CAR-T) therapy and vascular endothelial growth factor (VEGF)-targeted therapy, challenges have only increased. Since the first onco-nephrology forum at ASN Kidney Week