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Timothy O’Brien

Independently and together, changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) predict the risk of kidney and cardiovascular events and death in patients with type 2 diabetes, reports a study in a recent issue of CJASN.

“Our overall results suggest that a combined approach of determining clinically meaningful magnitudes of earlier change in both eGFR and UACR in type 2 diabetes may add substantial prognostic value to that associated with eGFR or albuminuria change alone,” concludes the report by John Chalmers, MD, PhD, of The George Institute for Global Health, University of New South

Timothy O’Brien

Crystals play a role in the development and progression of a wide range of diverse diseases, from gout to atherosclerosis to kidney disease. New experimental findings suggest that these crystallopathies may involve a “regulated process” of crystal-induced cell death called necroptosis, according to a report in Nature Communications.

The study also clarifies the steps in the pathway leading to necroptosis, suggesting promising new therapeutic targets to limit crystal-induced cytotoxicity and tissue injury. Necroptosis is just one of several recently recognized categories of “necroinflammation”—with distinct molecular pathways—potentially relevant to a wide range of kidney diseases.

Led by Prof. Hans-Joachim

Timothy O’Brien

Many children with kidney disease have rare “genomic imbalances” as the cause of their kidney dysfunction, often as part of neurodevelopmental syndromes. A new study finds that many unsuspected genetic diagnoses can be made using chromosomal microarrays to identify copy number variants (CNVs)—a “precision medicine” approach with major ramifications for treatment selection, family counseling, and long-term patient management.

The prospective study by a team of pediatric nephrologists and other specialists from seven centers found diagnostic copy number disorders in more than 7 percent of a large cohort of children with chronic kidney disease (CKD). “Detection of pathogenic imbalances has practical

Timothy O’Brien

Acute kidney injury (AKI) is a global problem affecting patients all over the world—but it’s not the same everywhere. A prospective, worldwide comparison of AKI patients revealed significant differences in patient characteristics, treatment, and outcomes between developed and emerging countries, according to a study in the Clinical Journal of the American Society of Nephrology.

Led by Ravindra Mehta, MD, of the University of California, San Diego, and Josée Bouchard, MD, of the University of Montreal, the researchers analyzed data on the characteristics, treatment patterns, and clinical outcomes in a worldwide sample of intensive care unit (ICU) patients with

Timothy O’Brien

Knowledge of phosphate crystals such as those shown from a 19th century urological dictionary aided yesterday’s practitioners. Advanced understanding of phosphates’ role in health may change how today’s clinicians practice.

Courtesy History and Special Collections for the Sciences, UCLA Louise M. Darling Biomedical Library.

Lowering serum phosphate levels may benefit three groups currently not often targeted for phosphate-lowering therapies, studies show. New dialysis patients, patients with early chronic kidney disease (CKD), and possibly

even healthy individuals with no clinical evidence of cardiovascular or renal disease may all benefit from reducing their high-normal phosphate levels.

Taking phosphorus binders reduced the risk

Timothy O’Brien

For patients with advanced chronic kidney disease (CKD), how much does getting recommended pre-dialysis care affect outcomes? Quite a bit—not only for the individual patient, but also at the level of the dialysis center, according to a study in the May Journal of the American Society of Nephrology.

Based on analysis of U.S. ESRD Network data, the study identified geographic “clusters” where patients are particularly unlikely to receive recommended pre-dialysis care. “Our observations suggest that pre-ESRD care may not vary randomly across communities and that less than optimal care aggregates within some treatment centers, and these centers tend

Timothy O’Brien

Two curious youths with urine flasks attend a group of physicians. Sparking curiosity about the kidneys could help spur young people to become nephrologists. See special section, p. 11.

Johannes de Ketham, Fasciculus Medicinae. In comincia el dignissimo Fasciculo de Medicina in Volgare. Venice: Giovanni & Gregorio di Gregorii, 5 Feb. 1493/4.

The Centers for Medicare & Medicaid Services’ (CMS) proposed fixed payment bundle system could have an unintended consequence—reduced access to dialysis for African Americans, suggests a study in the July Journal of the American Society of Nephrology.

Racial differences in hemoglobin levels and requirements for erythropoietin-stimulating

Timothy O’Brien

When it comes to the financial impact of the proposed ESRD bundled payment system, all dialysis centers may not be created equal. A study presented at Renal Week 2009 suggested that dialysis units with certain characteristics and in some regions—including some of the most impoverished regions in the United States—could see disproportionate cuts in Medicare payments under the new system.

Under a bundled payment system, Medicare makes a single reimbursement for all the hospital and physician care for kidney disease, rather than separate payments for the facility and physicians.

“Based on facility-level analysis, it appears there may be unanticipated geographic

Timothy O’Brien

Measures of the burden of chronic kidney disease (CKD) have risen dramatically in the 21st century—including more than 50% increases in rates of premature death and disability-adjusted life-years due to CKD. Those are among the alarming findings of a new analysis of changes in the health impact of CKD, published in late 2018 in JAMA Network Open (1).

The rising burden of CKD has occurred at a time when the United States has seen declining health burdens overall and from noncommunicable diseases in particular, according to the analysis of national and state-level data.

“Clearly, there needs to

Timothy O’Brien

In parenchymatous acute kidney injury, a large pale kidney presents with a thick, pale cortex and hyperemic pyramids.

What common acute medical condition occurs in about 5 percent of all hospitalized patients; has jumped in incidence by about one-third in recent years; is known to be a major risk factor for chronic organ dysfunction and death; and carries costs of about $10 billion per year? Nephrologists know the answer all too well: acute kidney injury (AKI)—or acute renal failure (ARF), as some call it.

While AKI is hardly a new disease, the past few years have witnessed an explosion of