• 1.

    Levey AS, et al. Nomenclature for kidney function and disease—executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Eur Heart J 2020; 41:45924598. doi: 10.1093/eurheartj/ehaa650

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  • 2.

    Levey AS, et al. Nomenclature for kidney function and disease: Executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Am J Transplant 2021; 21:901902. doi: 10.1111/ajt.16114

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    • Export Citation
  • 3.

    Kalantar-Zadeh K, et al. Nomenclature in nephrology: Preserving ‘renal' and ‘nephro' in the glossary of kidney health and disease. J Nephrol 2021; 34:639648. doi: 10.1007/s40620-021-01011-3

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    • Export Citation
  • 4.

    Levey AS, et al. Nomenclature for kidney function and disease: Report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int 2020; 97:11171129. doi: 10.1016/j.kint.2020.02.010

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What's in a Name, and Who's the Audience? “Kidney” vs. “Renal”

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A broad consensus exists that patients understand the word “kidney” better than “renal.” Thanks to that consensus, moves like the one for ASN to change its annual meeting from Renal Week to Kidney Week in 2011 to make its subject matter more understandable to the general public have been welcomed.

But the recent word usage proposals from a Kidney Disease: Improving Global Outcomes (KDIGO) meeting have proven more controversial. In June 2019, KDIGO convened a consensus conference in Amsterdam with the goal of standardizing and refining the English-language nomenclature to describe kidney function and disease. The “executive summary and glossary” of the meeting was published concurrently in 23 journals, a list that was wide ranging enough to include the European Heart Journal (1) and American Journal of Transplantation (2).

Although the stated aim was to present a “glossary,” one short phrase has generated backlash and debate: “Use the term ‘kidney' rather than ‘renal' to describe kidney function and kidney disease.”

As part of the pushback, a group of 27 leaders in nephrology, including several from the patient-advocate side, published a “point of view” in the Journal of Nephrology, “Nomenclature in nephrology: Preserving ‘renal' and ‘nephro' in the glossary of kidney health and disease” (3). The authors said: “‘Renal' and ‘nephro' should not be removed from scientific and technical writings. Instead, the terms can coexist and be used in their relevant contexts.”

The KDIGO guidelines do not call for removing “renal” and “nephro” from scientific and technical writings, according to Andrew Levey, MD, the lead author of a report that appeared in Kidney International (KI) (4), as well as the widely published executive summary: “The KDIGO consensus conference did NOT recommend that ‘kidney' should be used instead of ‘renal' or ‘nephro' in as many uses as possible. The recommendation applies for general terms related to kidney function and disease, not to specific anatomic structures, physiologic processes, or names of diseases (nor to names of clinical services or professional societies).”

Despite this interpretation, the statement—“use the term ‘kidney' rather than ‘renal' to describe kidney function and kidney disease”—does not contain any caveats about applying only to “general terms,” and some authors have complained that the policy is being implemented much more broadly than Levey's statement would have it.

Ask the editors

To clarify some of this debate, Kidney News contacted the editors of four respected nephrology journals to ask how they are implementing the KDIGO guidelines. The editors all participated in the KDIGO consensus conference.

They agree that even journals have some aspects that are more patient facing than others—such as abstracts and summaries— in which they are more likely to favor “kidney.” But they also said they are not trying to remove “renal” from scientific and technical writings.

The editors of the ASN-published journals, Journal of the American Society of Nephrology (JASN) and Clinical Journal of the American Society of Nephrology (CJASN), have taken somewhat different approaches, which ASN Executive Vice President Tod Ibrahim said is attributable to the “editorial firewall” between the publisher and the editors: “The editors of JASN, CJASN, Kidney360, and Kidney News have the authority to decide which terms to use in each publication, not ASN.”

JASN

JASN Editor-in-Chief Josephine Briggs, MD, said: “JASN is taking what I would call a light-touch approach to these issues. In the main text of the paper, we view this as a matter of author's choice. There are many settings where authors elect to use renal, and we do not feel it is essential to remove this word from our vocabulary. The critical issue is the context in which it is being used, and that is what I mean by a light touch.”

JASN does tend to favor “kidney” in the areas more likely to be read by lay audiences: “The significance statement is a brief summary of the highlights in the paper. The internet is increasing the extent to which people look at the scientific literature, and that was part of our notion of adding significance statements to our papers. We try to use ‘kidney' wherever it seems to be appropriate in outward-facing statements likely to be read by the general-public…. In these parts of the papers, we primarily use the term ‘kidney' unless there is a strong reason to use ‘renal.'”

CJASN

CJASN Editor-in-Chief Rajnish Mehrotra, MD, FASN, said the use of “renal” “depends upon the context in which it is being used. The editors review every paper and determine the appropriate nomenclature to be used. It is not something that has been so front and center and important to us that we have a written policy.”

“Our approach of not going down the path of ‘required nomenclature' is author friendly. One of the biggest complaints authors have is that each journal has its own unique formatting requirement. And if their paper is unsuccessful in one journal, authors can spend hours just reformatting to the requirements of the next journal. [For the articles we accept], we take it upon ourselves to guide the authors, rather than ask authors to take it on. We want rigor, and an important component of rigor is to be consistent in how information is presented in the journal. ‘Renal' vs. ‘kidney' is a very small part of the bigger whole of rigor such that [the] material [that] appears in the pages of CJASN is consistent from article to article, from issue to issue over the years,” Mehrotra said.

“We value patients accessing our content,” he added. “Three years ago, we started an article type that is called ‘the patient's voice,' where we invite a patient to review an article that we have published and provide a commentary on what that article means to [him or her] and the journey [he or she has] had with [his or her] illness.”

ASN supports the journals by issuing press releases to publicize the articles the editors deem the most newsworthy, and the press releases use lay-friendly language.

KI and American Journal of Kidney Diseases (AJKD)

Two other journal editors described similar approaches to the KDIGO recommendations.

Pat Morrissey, executive managing editor of KI, said in an email: “The policy at KI is to use ‘kidney' instead of ‘renal,' per KDIGO guidelines. However, this does not mean that the word ‘renal' is banned from use, but rather that the word ‘kidney' is preferred in most cases. ‘Renal' is very appropriate in some situations, but we simply agree with and encourage the use of ‘kidney' when possible.”

“As a rule, our KI copyeditors insert a general query into the author proofs asking authors to use the word ‘kidney' when describing kidney function, where applicable. The copyeditors do not make any changes to the proofs themselves in this respect. The query is only added as a suggestion to the authors,” she said.

“That being said, we do try to incorporate ‘kidney' vs. ‘renal' in the abstract since the idea of the KDIGO guidelines is to make nomenclature more understandable for the general reader, and the abstract might more likely be read by a broader audience,” Morrissey said.

Nijsje Dorman, PhD, managing editor of AJKD, said: “Like the 23 other journals that co-published the executive summary, we at AJKD endorse the spirit and sentiments of the KDIGO effort to enhance the precision and patient centeredness of the language used in nephrology. That said, we appreciate that subtleties and nuances are inherent in communication, and while we make an effort to incorporate the KDIGO glossary in our editing process, authors have the opportunity to review these suggestions at proof, and we do not dictate or overrule authors' word choice. From this collaborative process of editing, we hope to make AJKD's content accessible to the broadest swath of readers possible.”

General journals

Outside of the kidney space, more generalized journals are aware of the KDIGO recommendations but do not seem to be changing their policies as yet. The editors at the New England Journal of Medicine (NEJM) noted that they are aware of the KDIGO recommendations and the “changing trends in nomenclature within the field of nephrology favoring language that is ‘patient centered, precise, and consistent.' However, as there is not consensus across the field on this matter, we strive for clarity throughout each individual NEJM article without dictating one term over another.”

(The Journal of the American Medical Association [JAMA] editorial office said, “We have no comment” in response to a query from Kidney News on its policy.)

The KDIGO guidelines are for English usage, and the debate is clearly an English language-centered issue. The French word for kidney is “rein,” and the Spanish word is “riñon,” so speakers of these languages have no problem with “renal.”

“You talk to the non-English-speaking world—Spanish, French, and that is a huge part of the world—and they will tell you that they look at this whole issue in puzzlement, saying, ‘Why are you doing this? Renal makes so much more sense for us,'” said Swapnil Hiremath, MD, MPH, associate professor of medicine at the University of Ottawa in Canada and co-host of the NephJC podcast, Freely Filtered.

It is also noteworthy that despite the focus on the “kidney” vs. “renal” recommendation, the main thrust of the KDIGO guidelines was to provide a glossary on more technical terms. For example, the “key takeaways” included general items such as “avoid the use of ‘AKI' as a synonym for ‘AKD.'” The more technical recommendations sought to clarify nomenclature such as: “Avoid referring to ‘albuminuria' or ‘proteinuria' as ‘decreased kidney function.' Albuminuria and proteinuria are markers of kidney damage, rather than measures of kidney function.”

Organization names

As this internal debate continues, the “patient-facing” movement continued in July 2021, when the British Renal Society and the Renal Association completed a merger. The organizations agreed to drop the “renal” in favor of the name UK Kidney Association. The new name was “widely supported … as the preferred term for the UK professional organization representing all healthcare professionals involved in the care of patients with kidney disease,” the association's presidents Sharlene Greenwood and Paul Cockwell said in a statement to Kidney News.

In contrast, in the United States, the National Renal Administrators Association recently kept the “renal” when it changed its name to the Renal Healthcare Association.

Organizations continually grapple with the language they use to present themselves to the world, and ASN is no exception, according to ASN's Ibrahim: “All three words—American, society, and nephrology—have generated discussions. Because ASN is an international organization, with members in more than 130 countries, we've considered changing American to something more global. Many people also associate a society with a club, and we're a much broader, dynamic organization than that. Finally, with the emphasis on kidney health, the term nephrology merits consideration. That's part of the reason why we branded in July 2019 the ASN Alliance for Kidney Health, which includes ASN, KidneyCure, Nephrologists Transforming Dialysis Safety, the Kidney Health Initiative, and KidneyX.”

References

  • 1.

    Levey AS, et al. Nomenclature for kidney function and disease—executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Eur Heart J 2020; 41:45924598. doi: 10.1093/eurheartj/ehaa650

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Levey AS, et al. Nomenclature for kidney function and disease: Executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Am J Transplant 2021; 21:901902. doi: 10.1111/ajt.16114

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Kalantar-Zadeh K, et al. Nomenclature in nephrology: Preserving ‘renal' and ‘nephro' in the glossary of kidney health and disease. J Nephrol 2021; 34:639648. doi: 10.1007/s40620-021-01011-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Levey AS, et al. Nomenclature for kidney function and disease: Report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int 2020; 97:11171129. doi: 10.1016/j.kint.2020.02.010

    • Crossref
    • Search Google Scholar
    • Export Citation
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