The patient sitting in your office is in her low 30s, with an estimated GFR to match. She comes to you on referral from her primary care practice, unsure why she was referred, but the reason is pretty obvious to you. She has apparently been losing 5 grams of protein in her urine for some time—just how long isn’t clear because the proteinuria was first noticed 3 years ago but wasn’t quantitated, and this is the first time she has been referred to a nephrologist. She is moderately obese and takes three medications for her hypertension, including an angiotensin-converting enzyme inhibitor.
Practice Pointers
Kidney News Editorial Board member Edgar Lerma, MD, FASN, interviewed George Bakris, MD, FASN, about clinicians’ experience with the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines (1).
Dr. Lerma What are the highlights of the new ACC/AHA 2017 Hypertension Guidelines? How are they different from the previous guidelines?
Dr. Bakris Highlights and novel features of the new hypertension guidelines are as follows, compared with previous reports:
Kidney disease remains a leading cause of mortality in patients with diabetes
Diabetes is pandemic. Globally, diabetes affects up to half a billion people. In the US, one in 10 people have diabetes. Moreover, for Americans born in the year 2000, the lifetime risk of diabetes is a staggering 25% to 45%.
One disease or many?
IgA nephropathy (IgAN) is well identified by dominant IgA glomerular deposits; however, this immunohistologic entity can be an asymptomatic chance finding or present with an extremely variable course. The variable clinical and histologic expressions are likely to be the result of genetic and environmental factors modulating common pathogenetic and progression mechanisms.
IgA nephropathy (IgAN) is well identified by dominant IgA glomerular deposits; however, this immunohistologic entity can be an asymptomatic chance finding or present with an extremely variable course. The variable clinical and histologic expressions are likely to be the result of genetic and environmental factors modulating common pathogenetic and progression mechanisms.
This month, Kidney NewsEditorial Board member Edgar V. Lerma, MD, FASN, interviewed George Bakris, MD, FASN, FASH, FAHA, about recent SPRINT (Systolic Blood Pressure Intervention Trial) results. Dr. Bakris is professor of medicine and director of the ASH Comprehensive Hypertension Center at the University of Chicago Medicine.
KN: Why is the SPRINT study significant?
This month, Kidney News Editorial Board member Edgar V. Lerma, MD, FASN, interviewed George Bakris, MD, FASN, FASH, FAHA, about recent SPRINT (Systolic Blood Pressure Intervention Trial) results. Dr. Bakris is professor of medicine and director of the ASH Comprehensive Hypertension Center at the University of Chicago Medicine.
KN: Are we facing a higher incidence of nephrolithiasis?
Recent evidence suggests that over the past 4 decades, the incidence of kidney stones has increased in adults from 3.8 percent to 8.8 percent (1). In children, over the past 25 years, it has increased at a rate of 6 percent to 10 percent annually, reaching 50 cases per 100,000 adolescents (2).
Taking at least one hypertensive medication at bedtime instead of upon waking can reduce the risk of cardiovascular events by as much as two thirds, reports Ramón C. Hermida and associates in the December Journal of the American Society of Nephrology (JASN). This simple and costless approach could lead to significant improvements in outcomes for patients with high blood pressure (BP) whether or not they have chronic kidney disease (CKD) and could change how nephrologists administer antihypertensive drugs for their patients.
In this month’s issue, ASN Kidney News editorial board member Edgar Lerma interviewed Thomas Nevins, professor of pediatrics at the University of Minnesota Amplatz Children’s Hospital in Minneapolis, about nonadherence among patients—and care providers—in transplantation, dialysis, and kidney care in general.
What does the term nonadherence mean in nephrology?
Nephrologists in clinical practice take it for granted that when they arrive for morning rounds the hemodialysis machines will be set up and ready to go, with the water for the dialysate purified and inspected.
In fact, the level of water purity required to ensure patient safety has gradually evolved since hemodialysis was introduced many decades ago. The case study below, from a large community-based teaching hospital, illustrates how water quality can change unexpectedly, and the importance of rapid response to such changes to ensure patient safety.
In this month’s issue, ASN Kidney News editorial board member Edgar Lerma interviewed Stuart Linas, MD, about the American Board of Internal Medicine (ABIM) Maintenance of Certification program for nephrologists. Linas is the Rocky Mountain Professor of Renal Research at the University of Colorado Denver School of Medicine.
How common is access rupture?
In the January 2015 issue of ASN Kidney News:
- New Guidance on Statin Use in Patients with CKD
- Richard Lafayette, MD, FACP, Appointed Editor-in-Chief of ASN Kidney News
- Kidney Watch 2015: A Look at the Year Ahead
Read the Dynamic Edition
How common is access rupture? According to data reported to the Centers for Medicare & Medicaid Services, fatal rupture of arteriovenous (AV) dialysis access accounts for close to 0.4 percent of all hemodialysis deaths, which translates into about one death per 1000 hemodialysis patient years. A recent retrospective review of cases reported to the medical examiner in the District of Columbia, Maryland, and Virginia suggested that there is significant underreporting of such deaths (1).
What are some of the most important challenges facing nephrologists in prescribing dialysis therapy for their patients? Ever since dialysis therapy has proved to be lifesaving, we have been challenged to decrease the mortality and increase the safety of the procedure (1). Advances in technology have led to increasingly complex equipment, resulting in a steep learning curve for both clinicians and patients alike.
