Table of Contents
Overview
Definition of Nephrology
Nephrology is a specialized branch of medicine that focuses on the study and treatment of kidney-related conditions. It encompasses the understanding of normal kidney function, known as renal physiology, as well as the pathophysiology of kidney diseases. This specialty is crucial for both adult internal medicine and pediatric medicine, addressing the preservation of kidney health and the management of kidney diseases through various means, including dietary modifications, medication, and renal replacement therapy.[2.1] The term "nephrology" is derived from the Greek word 'nephros,' which translates to 'kidney,' and is pronounced as ne-FROL-uh-jee.[3.1] Nephrologists are the medical professionals who specialize in this field, providing comprehensive care and education to patients regarding their kidney health.[1.1]Importance of Kidney Health
Nephrology plays a crucial role in healthcare, particularly due to the rising prevalence of kidney diseases globally, which are often linked to increasing rates of diabetes and hypertension. The demand for nephrologists is significant as they are essential in managing these complex conditions and improving patient outcomes.[4.1] Chronic kidney disease (CKD) is a major public health concern, with an estimated 35.5 million adults in the United States affected, many of whom are unaware of their condition. Symptoms of kidney disease often do not manifest until the disease has progressed to severe stages, making early detection and management critical.[24.1] The classification of CKD into five stages reflects the severity of the disease, with most individuals remaining asymptomatic until they approach end-stage renal disease (ESRD).[23.1] Kidney health is significantly influenced by socioeconomic factors, which affect both the prevalence and outcomes of kidney diseases. Healthy People 2020, the US national blueprint for public health goals, explicitly aims to eliminate health disparities related to socioeconomic status among patients with kidney disease by 2020. This initiative includes a focus on reducing disparities in the occurrence and outcomes of chronic kidney disease (CKD), which are well-recognized issues in public health.[7.1] Furthermore, addressing the needs of patients with chronic kidney disease requires a commitment to data, education, and community engagement, particularly for those impacted by social determinants of health (SDOH).[27.1] Community education and awareness campaigns are essential for preventing kidney diseases and promoting early detection. Effective strategies include leveraging technology and social media to reach at-risk populations, enhancing support networks, and providing education on lifestyle changes that can mitigate risk factors associated with CKD.[28.1] The International Society of Nephrology (ISN) has also launched campaigns to raise awareness about CKD and its risk factors, promoting early detection through accessible resources.[30.1]History
Early Understanding of Kidney Function
The study of kidney function has evolved significantly over the centuries, beginning with early anatomical observations and culminating in more detailed physiological insights. Bartolomeo Eustachio (1514-1574) initiated the structural study of kidney function, while Jean Fernel (1497-1558) contributed to the understanding of its physiology and pathology. Joan Baptista Van Helmont (1577-1644) further advanced the field by chemically analyzing urine and identifying calculi as a principal cause of kidney disease during that era.[47.1] In the 17th century, Lorenzo Bellini made a groundbreaking contribution with his work "Anatomical Exercise on the Structure and Function of the Kidney," published in 1662. In this seminal text, Bellini revealed that the kidney is composed of numerous tiny canals, a discovery that significantly enhanced the understanding of renal anatomy.[63.1] This revelation led to the generation of new information regarding renal structure, function, and urine composition, both in health and disease, and established a foundation for future research in nephrology.[64.1] Prior to Bellini, Galen's studies of the kidneys represented a pivotal moment in medical history, bridging ancient practices with early anatomical understanding. His meticulous observations provided insights into renal function and pathology, influencing medical thought for centuries. Galen was among the first to accurately describe kidney function and the process of micturition, coining the term "ureter" and recognizing the importance of a competent ureterovesical junction.[66.1] These early contributions laid the groundwork for subsequent advancements in nephrology, shaping the trajectory of kidney research and understanding.Development of Nephrology as a Specialty
The development of nephrology as a specialty has its roots in significant historical milestones that have shaped the understanding and treatment of kidney diseases. One of the earliest contributions to nephrology was made by Galen, who recognized the urine-producing function of the kidneys, laying the groundwork for future anatomical studies of renal function.[43.1] The invention of the microscope further advanced the field, allowing for detailed examination of renal structures, with notable contributions from scientists like Bellini, who demonstrated the canalicular organization of the renal parenchyma.[43.1] In the 20th century, nephrology emerged as a distinct medical specialty, particularly in the latter half, due to groundbreaking advancements such as renal biopsy, dialysis, and kidney transplantation.[46.1] These developments transformed the diagnostic and therapeutic landscape of kidney diseases. Renal biopsy, in particular, shifted the diagnostic approach from a purely clinical methodology to one grounded in morphological analysis, significantly enhancing the accuracy of diagnoses.[46.1] The establishment of clinical practice guidelines by the U.S. National Kidney Foundation in 2002 marked another pivotal moment in nephrology, providing a standardized definition of chronic kidney disease (CKD) and introducing a classification system based on the severity of kidney function.[44.1] This framework has been instrumental in guiding clinical practice and improving patient outcomes. The Renaissance period also played a crucial role in the scientific study of nephrology, as it marked the beginning of a more systematic approach to understanding kidney function.[48.1] The intellectual movement of this era fostered advancements that have continued to evolve over the centuries, culminating in the sophisticated techniques and methodologies employed in modern nephrology.Common Kidney Diseases
Chronic Kidney Disease (CKD)
Chronic kidney disease (CKD) is the most common type of kidney disease, characterized by a gradual decline in kidney function over time.[83.1] The kidneys, which are two bean-shaped organs about the size of a fist, play a crucial role in filtering extra water and waste products from the blood to produce urine.[84.1] When the kidneys are damaged, as seen in CKD, they cannot filter blood effectively, leading to a buildup of waste in the body.[84.1] Individuals with diabetes or high blood pressure are at greater risk for developing kidney disease, including CKD.[84.1] Understanding these risk factors is essential for recognizing the potential for kidney damage and the importance of early intervention.[83.1] Several risk factors contribute to the development and progression of CKD, with diabetes mellitus (DMT2) and hypertension being among the most significant. Both conditions are chronic and can lead to further organ damage, exacerbating the effects of CKD.[86.1] The interplay between diabetes and CKD is complex, necessitating consistent monitoring and a multidisciplinary approach to manage the health of affected individuals effectively.[88.1] Furthermore, glycemic control is crucial in the early stages of CKD, as poor management can accelerate renal failure.[89.1] Dietary modifications are essential for managing Chronic Kidney Disease (CKD) at various stages. In the early stages, specifically Stage 1 and Stage 2 CKD, dietary changes aim to preserve kidney function, reduce blood pressure, and control blood glucose levels, as kidneys still function well during these stages.[93.1] It is crucial for individuals to work with a registered dietitian to develop a meal plan that includes enjoyable foods while maintaining kidney health.[90.1] As kidney function declines, particularly in later stages, adjustments in dietary intake become necessary, especially concerning phosphorus and potassium levels, to prevent further complications.[90.1] Healthcare professionals can assist in determining appropriate sodium intake based on the individual's stage of kidney disease and health status, and they advise avoiding salt substitutes that contain potassium, as CKD makes it difficult for the body to eliminate potassium from the blood.[91.1]Role Of Nephrologists
Responsibilities and Expertise
Nephrologists are medical doctors who specialize in diagnosing and treating kidney disorders. Their training includes extensive education in internal medicine followed by specialized training in nephrology.[123.1] These experts manage a wide array of kidney-related conditions, such as chronic kidney disease (CKD), kidney failure, and hypertension.[125.1] Additionally, nephrologists play a crucial role in the care of patients requiring dialysis and kidney transplants, as well as in the pre- and post-operative management of these patients.[125.1] Their expertise is essential not only in treating existing kidney conditions but also in preventing the progression of kidney disease, thereby potentially reducing the need for more invasive interventions.[125.1] In their role as primary care providers, nephrologists not only focus on kidney health but also offer general health care counseling, preventive care, immunizations, and management of minor acute illnesses unrelated to kidney failure.[122.1] They are integral to the care of patients with systemic diseases and comorbidities that affect kidney function, providing care across various settings such as clinics, inpatient units, and dialysis facilities.[126.1] Nephrologists also play a crucial role in the management of patients undergoing kidney transplantation, addressing the complex medical needs associated with this life-changing procedure.[131.1] Their responsibilities extend to pre-operative and post-operative care, ensuring that patients receive comprehensive support throughout the transplantation process.[125.1] Nephrologists play a vital role in advocating for public health initiatives that aim to raise awareness about kidney health and address the prevention of kidney disease at the community level. These initiatives are essential for educating the public about the risk factors associated with kidney disease and promoting early detection.[150.1] Advocacy and public policy efforts are conducted both externally and internally within the House of Medicine, significantly influencing the future of kidney care and nephrology practice.[149.1] As the COVID-19 pandemic wanes, there is an urgent need to improve kidney health literacy and early detection of chronic kidney disease (CKD) to compensate for shortages in the nephrology workforce.[152.1] Community health screening programs can be effective for the detection and prevention of kidney diseases; however, significant structural barriers can limit the effectiveness of these programs.[152.1] Furthermore, effective management of advanced CKD involves addressing co-morbidities such as uremia and cardiovascular disease, which are critical for avoiding or delaying dialysis or kidney transplantation.[151.1] The Advancing American Kidney Health Initiative has established goals to enhance efforts in preventing, detecting, and managing kidney disease, particularly by addressing traditional risk factors like diabetes and hypertension.[151.1]In this section:
Recent Advancements
Innovations in Treatment
Recent advancements in nephrology have led to significant innovations in the treatment of kidney diseases, particularly diabetic kidney disease (DKD) and chronic kidney disease (CKD). In 2023, research has continued to progress despite previous disruptions caused by the COVID-19 pandemic, with notable developments in clinical trials and new therapeutic agents.[165.1] One of the most promising advancements is the introduction of the non-steroidal mineralocorticoid receptor antagonist finerenone, which has demonstrated efficacy in reducing kidney and cardiovascular outcomes in patients with type 2 diabetes and CKD.[181.1] The FIDELIO-DKD trial, a phase 3 randomized study, highlighted finerenone's ability to significantly lower the risk of kidney failure and disease progression.[182.1] Furthermore, the integration of finerenone into treatment guidelines for DKD reflects its growing importance in clinical practice, although its high cost and the need for insurance preauthorization present challenges for widespread adoption.[183.1] In addition to finerenone, glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as effective treatments that not only lower blood sugar levels but also reduce blood pressure and albuminuria, making them particularly beneficial for patients with kidney disease and coronary artery disease.[185.1] A pooled analysis of trials involving finerenone and GLP-1RAs suggests that their combined use may enhance treatment outcomes across diverse patient populations with CKD and type 2 diabetes.[184.1] Recent clinical trials have highlighted the potential of new therapies such as sparsentan and budesonide in the treatment of proteinuric IgA nephropathy. Specifically, the PROTECT study demonstrated that once-daily treatment with sparsentan resulted in a significant reduction in proteinuria and preservation of kidney function, with a safety profile comparable to that of irbesartan.[169.1] Both sparsentan and budesonide trials utilized the accelerated approval pathway based on proteinuria reduction as a surrogate endpoint, and ongoing phases of these trials will assess their effectiveness in reducing hard endpoints of kidney disease.[170.1] Future analyses, following the completion of the two-year double-blind period, will determine whether the beneficial effects observed with sparsentan translate into long-term nephroprotective potential.[171.1] Sodium-glucose cotransporter-2 (SGLT2) inhibitors, initially developed for type 2 diabetes management, have also gained recognition for their nephroprotective effects, significantly reducing the risk of kidney failure and related complications.[177.1] Their mechanisms, including reduced kidney oxygen consumption and decreased intraglomerular pressure, differentiate them from traditional therapies.[178.1] As the field of nephrology advances, the integration of innovative therapies, such as virtual clinics for chronic kidney disease (CKD) patients, is gaining traction. These virtual clinics can facilitate remote monitoring and management, potentially reducing the need for emergency dialysis and improving long-term patient outcomes.[187.1] However, the incorporation of such technologies into routine clinical practice is still in its early stages, indicating that further research and development are necessary.[187.1] Additionally, the interdisciplinary nature of genomic research in nephrology is expected to lead to the creation of comprehensive, evidence-based guidelines for integrating genomic information into clinical practice.[186.1] Engaging patients and their families in genetic research can also provide valuable insights into the genetic factors influencing kidney disease, which is crucial for enhancing patient care.[186.1] Despite these promising developments, challenges such as the need for comprehensive guidelines and the complexities of insurance coverage remain significant considerations for the future of kidney disease management.Personalized Medicine in Nephrology
Recent advancements in nephrology have underscored the significant role of telemedicine, which offers various advantages in patient care. Telemedicine facilitates home therapy, reduces patient travel time and costs, and empowers patients by engaging them in self-care, which collectively enhances patient satisfaction and adherence to treatment protocols.[174.1] Clinical studies have indicated that telemedicine can improve patient satisfaction and treatment outcomes by increasing adherence and the frequency of visits, thereby positively impacting patient care.[172.1] Furthermore, the Centers for Medicare & Medicaid Services expanded telemedicine coverage on March 6, 2020, to include both inpatient and outpatient consultations as well as in-center hemodialysis, which has led to a rapid adoption of telemedicine in nephrology training programs.[173.1] This swift integration of telemedicine has allowed for more comprehensive care, effectively addressing the needs of patients in both outpatient and inpatient settings. Personalized medicine in nephrology has advanced significantly with the introduction of SGLT2 inhibitors, which confer renal protection through mechanisms such as tubuloglomerular feedback. This mechanism involves SGLT2 inhibitors causing increased sodium delivery along the nephron, which is sensed by macula densa cells. These cells then signal via adenosine to constrict afferent glomerular arterioles, thereby reducing intraglomerular pressure and protecting the glomeruli.[179.1] Notably, similar kidney benefits have been observed in nondiabetic patients with chronic kidney disease (CKD), prompting extensive research into the mechanisms by which SGLT2 inhibitors provide kidney protection.[180.1] Furthermore, the glucose-lowering efficacy and safety of SGLT2 inhibitors are almost comparable in patients with mild CKD to those with normal kidney function. However, in patients with moderate CKD, the efficacy tends to be dampened, and safety concerns may arise. The use of SGLT2 inhibitors is contraindicated in patients with severe CKD.[201.1] This highlights the importance of understanding the pharmacokinetics and pharmacodynamics of SGLT2 inhibitors in different patient populations, particularly those with varying degrees of kidney function.[202.1] Another promising area in personalized nephrology is the use of glucagon-like peptide-1 (GLP-1) receptor agonists. These agents have shown beneficial effects on cardiorenal outcomes beyond their glucose-lowering capabilities, making them a valuable option for managing DKD.[200.1] Clinical trials have indicated that GLP-1 receptor agonists can slow the progression of diabetic CKD and reduce the need for dialysis, further emphasizing the importance of personalized treatment strategies in nephrology.[200.1]In this section:
Diagnostic Techniques
Imaging and Laboratory Tests
Imaging techniques and laboratory tests are essential in the diagnosis and management of kidney diseases. The use of advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) has significantly increased the incidental detection of renal lesions, which often require further diagnostic evaluation using these well-established techniques.[226.1] A study comparing the diagnostic performance of CT and MRI in detecting renal cell carcinoma (RCC) found that MRI has a higher sensitivity of 90.0% compared to CT's sensitivity of 70.0%, indicating MRI's superior ability to correctly identify RCC cases.[228.1] However, CT demonstrated greater specificity at 87.5% compared to MRI's specificity of 67.5%, suggesting that while MRI is more effective at identifying RCC, CT is more accurate in confirming the absence of the disease.[228.1] This comparative analysis underscores the importance of both imaging modalities in clinical practice for evaluating unclear renal lesions.[225.1] In nephrology, a variety of diagnostic techniques are employed to assess kidney health and function. Common diagnostic tests include blood tests to check for infections, glucose levels, and other markers, as well as urinalysis to detect urinary tract infections or kidney problems.[207.1] Imaging studies, such as X-rays, CT scans, and MRIs, are also utilized to visualize internal structures.[207.1] The diagnostic landscape is evolving with the introduction of new biomarkers, including urinary albumin-to-creatinine ratio (UACR), kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL), which are supplanting traditional markers and providing valuable insights into kidney health.[206.1] Although these biomarkers are not yet ready for clinical use, they are significant in reviewing the role of predicting chronic kidney disease (CKD) progression and cardiovascular disease (CVD) risk in CKD patients.[235.1] Kidney biopsies are essential diagnostic procedures, particularly indicated for new-onset nephrotic syndrome in adults, cases of significant proteinuria, and instances of unexplained renal impairment, especially when active urine sediment suggests possible crescentic glomerulonephritis.[210.1] In the field of nephrology, traditional diagnostic techniques remain crucial, as they provide vital information regarding kidney function and disease progression, which is fundamental for effective clinical management.[230.1] The reliance on these traditional indicators is underscored by the necessity of monitoring disease and the response of laboratory tests to treatment, highlighting their importance in patient management.[231.1]Emerging Technologies in Diagnosis
Emerging technologies in nephrology diagnostics are increasingly focused on non-invasive methods that enhance the assessment of kidney health and disease progression. One notable advancement is ultrasound elastography (USE), which has gained traction for its ability to evaluate tissue elasticity in patients with chronic kidney disease (CKD) and has shown promise in both native and transplanted kidneys.[211.1] Specifically, shear wave elastography (SWE) has been explored as a potential non-invasive biomarker to differentiate between normal and abnormal renal parenchymal tissue, addressing the pressing need for reliable measures of renal fibrosis.[212.1] Chronic kidney disease (CKD) is recognized as a major worldwide health problem, with intra-renal fibrosis serving as a final common pathway that correlates with disease severity.[213.1] The measurement of tissue stiffness can be performed non-invasively using shear wave elastography (SWE), representing a significant advancement in nephrology diagnostics.[213.1] Current biomarkers for CKD are limited by their lack of sensitivity and inability to prognosticate disease progression.[215.1] However, emerging biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and liver-type fatty acid-binding protein (L-FABP) have been linked to kidney damage, disease severity, and progression, indicating their potential to enhance the diagnostic landscape in nephrology.[214.1] These emerging biomarkers have been examined in multiple studies and validated independently in separate cohorts, suggesting their reliability in clinical settings.[215.1] Current biomarkers for CKD often lack sensitivity and prognostic capability, highlighting the importance of these emerging biomarkers that have been validated across multiple studies.[215.1] Additionally, advancements in laboratory techniques have improved the accuracy and efficiency of kidney function tests, which are crucial for monitoring patients with conditions such as diabetes and hypertension.[216.1] Calibration improvements in creatinine measurements have also reduced misclassification bias in estimating glomerular filtration rate (eGFR), further refining diagnostic accuracy.[217.1] The exploration of novel biomarkers, including Cystatin C and ProEnkephalin, aims to overcome the limitations of traditional renal function assessments, thereby enhancing the precision of kidney diagnostics.[218.1] As these technologies evolve, they promise a paradigm shift in nephrology, offering real-time monitoring and greater applicability across diverse patient populations.[219.1]In this section:
Patient Care And Management
Lifestyle Modifications for Kidney Health
Lifestyle modifications are vital in managing kidney health, especially for patients with chronic kidney disease (CKD). These modifications include medication management, dietary guidelines, and regular monitoring, forming the foundation of effective CKD care plans tailored to individual patient needs.[266.1] A comprehensive approach ensures that all critical elements of CKD management are addressed, focusing on treatment strategies that consider the underlying causes, individual characteristics, and specific needs of each patient.[266.1] For hypertensive kidney disease, a tailored approach is essential for optimizing health outcomes and effectively managing kidney health.[265.1] A structured framework, such as a Chronic Kidney Disease Care Plan, is crucial to ensure that all aspects of CKD management are addressed for each patient.[266.1] Regular monitoring is particularly important, as CKD is characterized by irreversible kidney damage, which can be assessed through the glomerular filtration rate (GFR). The GFR is a key indicator of kidney function, reflecting the flow rate of filtered fluid through the kidneys and serving as an accurate measure of overall kidney health.[271.1] Nephrology care emphasizes culturally sensitive practices as a best-practice approach for improving health outcomes among patients with end-stage kidney disease (ESKD).[273.1] This care is crucial for hemodialysis patients, requiring significant lifestyle changes.[273.1] Nephrology nurses play a vital role in addressing the holistic needs of these patients by establishing culturally sensitive practices that consider their social support systems, life goals, preferences, functional status, and logistical factors.[267.1] The ESKD Life-Plan promotes shared decision-making (SDM) among patients and their dialysis care teams, allowing for the development of individualized treatment plans that specifically consider the patients' current medical situations and future aspirations.[267.1] Evidence supports the effectiveness of nurse-led care in improving various aspects of health, including quality of life, sleep, pain, overall health, and depressive symptoms among CKD patients, demonstrating the positive impact of such interventions on patient outcomes.[270.1] By fostering a supportive environment, nephrology care not only aids in disease management but also encourages adherence to necessary lifestyle modifications.[270.1]Support Systems for Patients
Support systems for patients with kidney disease are essential for enhancing their overall well-being and quality of life. Shared decision-making (SDM) is a critical component of these support systems, as it involves collaboration between patients and healthcare providers to arrive at informed medical decisions. Evidence indicates that SDM not only increases patients' understanding of their illness but also enhances their satisfaction with the decision-making process.[251.1] This approach allows patients to actively participate in discussions about their treatment options, risks, and benefits, thereby aligning interventions with their preferences and priorities.[253.1] Patient-centered care in nephrology signifies a transformative approach that shifts the focus from a disease-centered model to one that prioritizes the unique experiences of patients. This model fosters active participation and collaboration between patients and healthcare professionals, allowing for a more personalized care experience.[252.1] By engaging patients in their health journey, this philosophy empowers them, making them feel valued and involved in their treatment decisions. The implementation of individualized care plans, patient education, and shared decision-making not only enhances patient engagement but also promotes improved treatment adherence and a sense of ownership over health outcomes.[254.1] Ultimately, this approach aims to transcend traditional boundaries in nephrology, striving to achieve the best possible treatment outcomes and quality of life for individuals living with kidney disease.[252.1] Effective strategies to empower patients include minimizing the burden of chronic kidney disease (CKD)-related symptoms, which can significantly enhance patient satisfaction and health-related quality of life.[255.1] Additionally, addressing patients' psychosocial needs is crucial. Patients often express feelings of helplessness and a lack of control over their illness, which can be mitigated by ensuring they feel listened to and educated about their treatment options.[261.1] Psychosocial interventions can help reduce distressing symptoms, increase coping strategies, and foster social connectedness, although there is currently no uniform standard for these treatments.[263.1] Education programs that involve care partners are also vital in promoting informed and activated patients with CKD. Such programs empower patients to take control of their health, ultimately improving outcomes and quality of life.[275.1] Resources like Interwell Learning, which offers a reimbursable kidney disease education series, exemplify effective patient education initiatives that combine various formats to enhance understanding and engagement.[276.1] Furthermore, organizations like the National Kidney Foundation provide a range of resources, including support networks and educational materials, to assist patients in navigating their health challenges.[277.1]In this section:
Future Directions In Nephrology
Research Trends and Focus Areas
Recent advancements in nephrology have highlighted several key research trends and focus areas that are shaping the future of kidney care. One significant area of focus is the prevention and management of acute kidney injury (AKI) and chronic kidney disease (CKD), with ongoing efforts to develop innovative treatment modalities and guidelines aimed at improving patient outcomes.[289.1] Emerging therapeutic strategies are particularly noteworthy, with the introduction of non-steroidal mineralocorticoid receptor antagonists, such as finerenone, and glucagon-like peptide-1 (GLP-1) receptor agonists, like semaglutide, showing promise in enhancing treatment for diabetic kidney disease.[290.1] Additionally, the exploration of novel diagnostic methods, including advancements in kidney imaging and renal function estimation, is expected to revolutionize the approach to kidney disease management.[293.1] Research is also increasingly directed towards understanding the pathophysiology of kidney diseases and identifying novel therapeutic targets. This includes the investigation of kidney-specific proteins and the development of combination therapies that address residual cardiorenal risk in CKD patients.[296.1] Furthermore, the integration of personalized medicine, which tailors treatment strategies based on genetic factors and disease progression, is anticipated to significantly influence future treatment paradigms for CKD.[298.1] The role of health policy in nephrology is increasingly vital, particularly as advocacy efforts intensify to ensure that Americans on dialysis have access to innovative treatments. A coalition of over 100 stakeholders, including patient advocacy groups, racial equity organizations, labor unions, and faith leaders, has urged Congress to pass the Kidney PATIENT Act (H.R. 5074 / S.4510) to facilitate this access.[305.1] Furthermore, organizations like the National Kidney Foundation (NKF) are at the forefront of this movement, working to eliminate preventable kidney disease and dismantle structural inequities in kidney care, dialysis, and transplantation. The NKF is committed to providing fair, equitable, and innovative treatment options, thereby enhancing the dignity of the patient experience.[306.1] Overall, the future of nephrology research and policy is characterized by a concerted effort to address disparities and improve kidney health for underserved populations.Potential Impact of Artificial Kidneys
The development of wearable artificial kidneys (WAK) represents a significant advancement in the field of nephrology, particularly for patients with end-stage renal disease. The WAK is a battery-operated device that weighs less than 5 kg and can be worn like a belt or vest, allowing for greater mobility and independence compared to traditional dialysis methods. This innovation aims to eliminate barriers associated with home hemodialysis, such as the need for electricity and water supply, thereby enhancing patient convenience and quality of life.[301.1] Collaboration among researchers from various fields is essential to address the challenges of creating effective wearable and implantable artificial kidneys. These devices must be capable of performing vital kidney functions, including the removal of uremic toxins, maintaining electrolyte balance, and regulating fluid levels.[302.1] However, the integration of wearable artificial kidneys into everyday patient care is not without its challenges. Key issues include ensuring patient acceptance and education, as both patients and healthcare providers need to understand the functionality and benefits of these devices.[303.1] Moreover, safety and user acceptance are critical factors that will influence the widespread adoption of wearable artificial kidneys. For successful implementation in real-world settings, it is imperative to establish safe blood access and address any potential complications that may arise during use.[304.1] As these challenges are navigated, the potential impact of wearable artificial kidneys on patient care could be transformative, offering a more flexible and less burdensome alternative to conventional renal replacement therapies.In this section:
Acute Kidney InjuryInnovative TreatmentTherapeutic TargetsHealth PolicyInnovative Treatments
References
[1] Exploring Kidney Health: A Beginner's Overview of Nephrology — Kidney health is a vital aspect of overall well-being, yet many individuals may not fully understand the complexities of nephrology—the branch of medicine dedicated to the study and treatment of kidney-related conditions. At Richmond Nephrology Associates, we're committed to providing comprehensive care and education to our patients. In this beginner's guide to nephrology, we'll
[2] Nephrology - Wikipedia — Nephrology is a specialty for both adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function (renal physiology) and kidney disease (renal pathophysiology), the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy
[3] Understanding the Basics of Nephrology: A Comprehensive Guide — Understanding the Basics of Nephrology The field of medicine is vast and complex. Each specialty plays a crucial role in maintaining human health. One such specialty is nephrology. This branch of medicine focuses on the study and treatment of kidney diseases. Nephrology is derived from the Greek word 'nephros,' meaning kidney. It is pronounced as ne-FROL-uh-jee. Nephrologists, the
[4] The Vital Role of Nephrologists | Understanding Nephrology — Nephrology remains critically important in healthcare due to the increasing prevalence of kidney diseases worldwide, often resulting from rising cases of diabetes and hypertension. The demand for nephrologists continues as they are key in managing these complex conditions and improving patient outcomes. Why is Consulting a Nephrologist Important?
[7] Influence of race, ethnicity and socioeconomic status on kidney disease ... — Healthy People 2020—the US national blueprint for public health goals—explicitly aims for the elimination of socioeconomic-related health disparities among patients with kidney disease in the USA by 2020. 5 Included in this goal is the reduction of disparities in the occurrence and outcomes of CKD, reflecting the marked and well-recognized
[23] Signs and symptoms of kidney disease - American Kidney Fund — Chronic kidney disease is classified in stages 1-5, which correspond to the severity of underlying kidney disease. Most people do not have symptoms of kidney disease until the damage is very severe and they are close to kidney failure, also called end-stage renal disease (ESRD) or end-stage kidney disease (ESKD).
[24] 10 Signs You May Have Kidney Disease — An estimated 35.5 million U.S. adults have kidney disease. Most don't know they have it. "There are a number of physical signs of kidney disease, but sometimes people attribute them to other conditions," said Dr. Joseph Vassalotti, Chief Medical Officer at the NKF. "Those with kidney disease tend not to experience symptoms until the very late stages, when the kidneys are failing or
[27] Contributor: Data, Education, and Community: The Winning Formula for ... — Addressing patients with chronic kidney disease requires a commitment to data, education, and community, specifically in those affected by social determinants of health (SDOH).
[28] Public health campaigns for CKD prevention - Wiki Chronic kidney disease — Public health campaigns for chronic kidney disease (CKD) prevention play a crucial role in raising awareness, educating communities, and promoting healthy behaviors that can reduce the risk of CKD. Effective campaigns leverage various strategies to reach diverse populations, focusing on education, access to resources, and lifestyle changes.
[30] Policies & Campaigns - International Society of Nephrology — The ISN launched a public awareness campaign in 2021 highlighting chronic kidney disease (CKD) and its risk factors and promoting early detection in at-risk categories. "Are your kidneys healthy?" is a quick online quiz, available in 17 languages, which helps people gauge their risk of kidney disease and indicates when they should see a doctor.
[43] History of Development of Nephrology : Saudi Journal of Kidney Diseases ... — There are important dates which can be considered as milestones in the history of Nephrology. Galen, was the first anatomist to recognize the urine producing function of the kidney. Later on, with the invention of the microscope, new doors opened for the study of renal structure. Bellini proved the canalicular organization of the paranchyma.
[44] History of nephrology and renal transplantation timeline — History of nephrology and renal transplantation timeline - Chronic Kidney Disease Explained Sándor Korányi (1866-1944; physiologist and physician from Budapest) developed physicochemical tests – e.g. to measure the kidney’s ability to maximally concentrate the urine – to estimate renal function. In 2002, the U.S. National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines (Levey et al) provided for the first time a working definition of CKD (a name that replaced chronic renal failure, CRF) irrespective of the cause of kidney disease. The proposed classification system – with 5 stages of CKD – was based on the severity of the disease derived from the level of kidney function, irrespective of diagnosis.
[46] History of nephrology: modern era - Hektoen International — George DuneaChicago, Illinois, United States Twentieth century Three major developments—renal biopsy, dialysis, and transplantation—revolutionized nephrology in the second half of the 20th century. Renal biopsy transformed the diagnostic approach to renal disease from a clinical methodology to one based on morphological analysis. Presently over one million patients with renal failure are
[47] The Renaissance Kidney-Nephrology in and about the Sixteenth Century ... — The study of the structural basis of kidney function was launched by Bartolomeo Eustachio (1514-1574); the elements of its physiology and pathology were promulgated by Jean Fernel (1497-1558), and that of the chemical study of urine and of the principal cause of kidney disease then, calculi, instigated by Joan Baptista Van Helmont (1577-1644).
[48] The Renaissance Kidney—Nephrology in and about the Sixteenth Century ... — The Renaissance Kidney—Nephrology in and about the Sixteenth Century. Garabed Eknoyan, Garabed Eknoyan. Renal Section, Department of Medicine, Baylor College of Medicine, Houston, Texas. ... but it is in the intellectual movement of the Renaissance that its actual scientific study began in earnest and has not ceased growing since then. It was
[63] Lorenzo Bellini | Anatomy, Physiology, Medicine | Britannica — In Exercitatio anatomica de structura et usu renum (1662; "Anatomical Exercise on the Structure and Function of the Kidney"), published when he was a 19-year-old student at the University of Pisa, Bellini showed for the first time that the kidney consists of an immense number of tiny canals.
[64] The enlightenment kidney-nephrology in and about the ... - PubMed — This led to the generation of new information on renal structure, function, and urine composition in health and to some extent in disease. Studies on the dissected, injected, and teased kidneys have left us with many of the eponymous renal structures described by Eustachio, Bellini, Malpighi, and Ferrein.
[66] Claudius Galen: From a 20th Century Genitourinary Perspective — Galen's remarkable observations and novel concepts expanded medical knowledge in general and contributed to fundamental genitourinary principles in particular. Galen was one of the first to describe correctly the function of kidneys and explain micturition. Among his many neologisms he coined the term ureter, and he was probably the first to recognize the value of a competent ureterovesical
[83] What Are the Most Common Kidney Diseases? - MedicineNet — The most common type of kidney disease is chronic kidney disease (CKD). Other diseases include acute kidney injury, stones, infections, cysts, and cancer. Kidneys perform essential functions such as filtering blood to remove waste products and excess fluid from the body.
[84] Kidney Disease - NIDDK — The kidneys are two bean-shaped organs. Each kidney is about the size of a fist. Your kidneys filter extra water and wastes out of your blood and make urine. Kidney disease means your kidneys are damaged and can't filter blood the way they should. You are at greater risk for kidney disease if you have diabetes or high blood pressure.
[86] Diabetes and Chronic Kidney Disease: Connection, Risks - Verywell Health — Connection Between Diabetes and Chronic Kidney Disease Both diabetes and CKD are chronic illnesses , meaning that they are persistent and typically progressive. Over time, they can cause damage to multiple organs, leading to such comorbid conditions as hypertension (high blood pressure), hyperlipidemia (high cholesterol), and cardiovascular
[88] Management of Diabetes in Patients with Chronic Kidney Disease — Background: Patients with diabetes and chronic kidney disease (CKD) are at increased risk of kidney disease progression and cardiovascular events. Methods: In this article, we will summarize the 2022 consensus report by the ADA and KDIGO on diabetes management in CKD and include newly available evidence to assist health care professionals in providing optimal care to patients living with
[89] Interactions between kidney disease and diabetes: dangerous liaisons — Chronic kidney disease mechanisms predisposisng to hyperglycaemia and hypoglycaemia. Glycemic monitoring in CKD. As lack of glycemic control increases the rate of progression of renal failure, proper glycemic control in the early stages of CKD is crucial [].The United Kingdom Prospective Diabetes Study (UKPDS) provided the first evidence that intensive glycemic control, determined by a more
[90] Eating Right for Chronic Kidney Disease - NIDDK - National Institute of ... — Work with a registered dietitian to develop a meal plan that includes foods that you enjoy eating while maintaining your kidney health. The steps below will help you eat right as you manage your kidney disease. As your kidney function goes down, you may need to eat foods with less phosphorus and potassium. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood, and you can work with your dietitian to adjust your meal plan. More information is provided in the NIDDK health topic, Nutrition for Advanced Chronic Kidney Disease. This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.
[91] Diet & Nutrition for Adults with Advanced Chronic Kidney Disease — However, your health care professional or dietitian can help you determine how much sodium is right for you, based on your stage of kidney disease and your health status. People with CKD should avoid using salt substitutes that contain potassium, because kidney disease makes it harder for the body to remove potassium from the blood. Talk with a dietitian or health care professional about how much potassium you should have for your stage of kidney disease. Learn more about which foods are higher or lower in phosphorus in Phosphorus: Tips for People with Chronic Kidney Disease (CKD) (PDF, 914.53 KB) . When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.
[93] What to Eat When You Have Stage 1 or 2 Kidney Disease — When you discover that you're in the early stages of chronic kidney disease (CKD), it's time to make some lifestyle changes, particularly dietary ones.. Kidneys still work well in stage 1 and stage 2 CKD.The focus of this type of kidney diet is to make changes that may preserve kidney function, reduce blood pressure and, in people with diabetes, control blood glucose.
[122] The Dual Role of the Nephrologist in Patient Care — Nephrologists, in their role as primary care providers, offer general health care counseling, preventive care, referrals, immunizations, and care of minor acute illnesses that are unrelated to a patient's kidney failure.
[123] Understanding the role of Nephrologist - Innovative Renal Care — A nephrologist is a medical doctor who specializes in diagnosing and treating kidney disorders. Their training includes extensive education in internal medicine followed by specialized training in nephrology. Nephrologists are experts in managing a range of conditions related to the kidneys and are integral to the care of patients with chronic kidney disease (CKD), kidney failure, and other
[125] The Vital Role of Nephrologists | Understanding Nephrology — Billing FAQs who specializes in the diagnosis, treatment, and management of kidney diseases. disease, kidney transplant and management of dialysis. Nephrologists manage a wide array of kidney-related conditions, such as hypertension, kidney for patients with end-stage renal disease and in the pre and post-operative care of kidney The Impact of Nephrologists on Kidney Care The role of nephrologists extends beyond treating existing kidney conditions. management can slow down the progression of kidney disease, potentially preventing the need urination, high blood pressure, or those with a family history of kidney disease, should consult a In sum, Nephrologists are key in taking care of kidney diseases and helping to prevent them. The Global Impact of Kidney Disease The Global Impact of Kidney Disease
[126] The Importance of Transplant Nephrology to a Successful Kidney ... — Nephrologists are responsible for the care of patients with a diverse array of systemic diseases, comorbidities, and kidney issues across a variety of service locations (clinic, inpatient, dialysis unit).
[131] Securing the future of kidney transplantation by addressing the ... — Kidney transplant is a life-changing procedure, and transplant nephrologists, as part of a larger transplant team, play an important role in the field by managing the complex medical needs of transplant patients. The subspecialty of transplant nephrology, however, faces structural challenges related to its workforce, reporting structures, compensation, research and innovation, and health care
[149] Nephrologist Leadership in Advocacy and Public Policy — Advocacy and public policy are conducted externally as well as internally to the House of Medicine and shape the future of kidney care and nephrology practice. This article explores the impact of nephrology leadership on government decision making and the important role of the nephrologist in advocacy and public policy at the Federal, state
[150] Chronic Kidney Disease Prevention: The Role of Public Health ... — Chronic Kidney Disease Prevention: The Role of Public Health Initiatives and Community Programs Chronic Kidney Disease Prevention: The Role of Public Health Initiatives and Community Programs Chronic Kidney Disease Prevention: The Role of Public Health Initiatives and Community Programs Public health initiatives are critical to raising awareness and addressing risk factors for kidney disease. Public health and community initiatives are very important in making people aware of the risk factors associated with kidney disease and early detection. Previous Post Mental Health in Dialysis Patients: Understanding the Psychological Impact of Chronic Kidney Disease and Dialysis Chronic Kidney Disease Prevention: The Role of Public Health Initiatives and Community Programs Mental Health in Dialysis Patients: Understanding the Psychological Impact of Chronic Kidney Disease and Dialysis
[151] Kidney health for everyone everywhere - from prevention to detection ... — In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Intervention after screening is also important and patients detected with CKD should be referred to primary care and general physicians with experience in management of kidney disease for follow up. The program, known as the Advancing American Kidney Health Initiative, has set goals with metrics to measure its success; among them is to increase efforts to prevent, detect, and slow the progression of kidney disease, in part by addressing traditional risk factors like diabetes and hypertension.
[152] Leveraging Resources Effectively at the Community Level: Lessons ... — As the COVID-19 pandemic wanes, we must improve kidney health literacy and the early detection of CKD to make up for shortages in the nephrology workforce. Community health screening programs can be effective for the detection and prevention of kidney diseases, but significant structural barriers limit the strength of these programs.
[165] Articles in 2023 | Nature Reviews Nephrology — Basic discovery and clinical trials in diabetic kidney disease (DKD) have continued to be reported in 2023 despite the disruption of research activity by COVID-19 in recent years. Advances in
[169] Sparsentan Clinical Trials Results and Pharmacokinetic Considerations ... — This article summarizes key findings from sparsentan clinical trials, presented at the American Society of Nephrology Kidney Week 2023. 1 Findings In the PROTECT study , sparsentan demonstrated significantly reduced proteinuria, preservation of kidney function, and a comparable safety profile to irbesartan 9-11
[170] Sparsentan and the Expanding Landscape of IgA Nephropathy... : Clinical ... — Importantly, as both the sparsentan and budesonide trials leveraged the accelerated approval pathway on the basis of a reasonably likely surrogate end point (proteinuria reduction), ongoing phases of these trials 6, 8 will test whether these agents are effective in reducing hard end points of kidney disease. In addition to direct assessment of
[171] Sparsentan in patients with IgA nephropathy: a prespecified interim ... — Once-daily treatment with sparsentan produced meaningful reduction in proteinuria compared with irbesartan in adults with IgA nephropathy. Safety of sparsentan was similar to irbesartan. Future analyses after completion of the 2-year double-blind period will show whether these beneficial effects translate into a long-term nephroprotective potential of sparsentan.
[172] Telemedicine in nephrology: future perspective and solutions — Clinical studies have been conducted on telemedicine in nephrology outpatient care, inpatient consultations and hemodialysis, indicating that telemedicine can improve patient satisfaction, leading to enhanced treatment owing to increased adherence and frequency of visits. ... and having less impact on work and employment from a patient-related
[173] Lessons Learned: Nephrology Training Program Adaptation in the Time of ... — The Centers for Medicare & Medicaid Services expanded telemedicine coverage on March 6, 2020 to include inpatient and outpatient consultation and in-center hemodialysis. 2 While isolated telemedicine programs existed pre-COVID for rural and transplant care, the rapid adoption of telemedicine left many nephrology training programs scrambling to
[174] Telemedicine in nephrology: future perspective and solutions — The advantages of telemedicine include facilitating home therapy, reducing patient travel time and costs, empowering patients and engaging them in self-care, and having less impact on work and employment from a patient-related perspective (Table 1). From a health-economic perspective, telemedicine's advantages include a reduction in staff
[177] Kidney protective mechanisms of SGLT2 inhibitors: evidence for a ... — Sodium-glucose cotransporter-2 (SGLT2) inhibitors were introduced a decade ago for the treatment of type 2 diabetes (T2D) and have emerged as a key therapy for the treatment of chronic kidney disease (CKD). In trials with primary kidney end points, SGLT2 inhibitors reduced the composite of kidney failure, kidney death, and doubling of serum creatinine by 28% to 39%.1 Benefits of this class of
[178] Comparison of Effectiveness Among Different Sodium‐Glucose ... — A possible explanation for the reno‐protective effect of SGLT2 inhibitors is the reduction in kidney oxygen consumption. 38 Another potential explanation includes the attenuations in intraglomerular pressure and kidney inflammatory reactions. 39, 40, 41 While SGLT2 is mainly expressed in the kidney, SGLT1 is expressed in the brush border of
[179] Renal Protection with SGLT2 Inhibitors: Effects in Acute and Chronic ... — A key mechanism is tubuloglomerular feedback in which SGLT2 inhibitors cause more sodium to pass along the nephron: the sodium is sensed by macula cells which act via adenosine to constrict afferent glomerular arterioles, thereby protecting glomeruli by reducing intraglomerular pressure.
[180] Kidney protective mechanisms of SGLT2 inhibitors: evidence for a ... — Furthermore, in nondiabetic patients with CKD, similar kidney benefits are observed. 2,3 These findings have led to a body of research investigating the mechanisms by which SGLT2 inhibitors confer kidney protection.
[181] Finerenone in chronic kidney disease and type 2 diabetes: the known and ... — The novel nonsteroidal mineralocorticoid receptor antagonist finerenone has been shown to reduce the risk of kidney and cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease. In this issue of Kidney International, Bakris et al. present new data on the kidney efficacy of finerenone across subgroups of estimated glomerular filtration rate and urinary albumin-to
[182] Finerenone: From the Mechanism of Action to Clinical Use in Kidney Disease — Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) was a phase 3 randomized double-blind placebo-controlled multicenter clinical trial. In this study, authors Bakris et al. (2020) randomly assigned 5734 patients with CKD and type 2 diabetes in a 1:1 ratio to receive either finerenone or placebo.
[183] Finerenone Added to Treatment Guidelines for Type 2 Diabetes and ... — The use of finerenone is now included in the 2022 revision to standard treatment guidelines for patients with type 2 diabetes and chronic kidney disease.Finerenone is a costly addition to standard treatment. Patients may need to receive prescription preauthorization from their insurer.
[184] Finerenone in patients across the spectrum of chronic kidney disease ... — Aims: To explore the modifying effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) use on outcomes with finerenone across a wide spectrum of patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the pooled analysis of FIDELIO-DKD and FIGARO-DKD. Materials and methods: Patients with T2D and CKD treated with optimized renin-angiotensin system blockade were randomized
[185] Game-Changing Medications For Kidney Disease and Type 2 Diabetes — This class of medications is especially recommended for people with kidney disease and coronary artery disease, including heart attack, coronary stents, or bypass surgery. GLP-1 RA medications are effective at lowering 2: A1C levels; Blood pressure; Risk of cardiovascular events; Blood sugar; Albuminuria; Medications in the GLP-1 RA class:
[186] Journal of Clinical Nephrology and Therapeutics — The interdisciplinary nature of genomic research in nephrology will enable the development of comprehensive, evidence-based guidelines for integrating genomic information into clinical practice. Furthermore, the involvement of patients and their families in genetic research can provide valuable insights into the genetic factors that influence
[187] Exploring the metaverse: opportunities for nephrology in ... - PubMed — The development of virtual clinics for CKD patients could facilitate remote monitoring and management, reducing the need for emergency dialysis and improving long-term patient outcomes. Despite the burgeoning interest and research in this field, the integration of VR and AR into routine clinical practice remains in its nascent stages.
[200] Emerging evidence for glucagon-like peptide-1 agonists in slowing ... — Summary: GLP-1 receptor agonism is a promising therapy for slowing the progression of diabetic chronic kidney disease. Recent studies support kidney benefits GLP-1 receptor agonists over insulin and dipeptidyl peptidase-4-inhibitors, and the FLOW-CKD trial would inform the potential benefits for reducing the need for dialysis and kidney-disease
[201] Pharmacokinetics, Pharmacodynamics and Clinical Use of SGLT2 Inhibitors ... — Nevertheless, the glucose-lowering efficacy and safety of SGLT2 inhibitors are almost comparable in patients with mild CKD as in patients with normal kidney function. In patients with moderate CKD, the efficacy tends to be dampened and safety concerns may occur. In patients with severe CKD, the use of SGLT2 inhibitors is contraindicated.
[202] Pharmacokinetics, Pharmacodynamics and Clinical Use of SGLT2 Inhibitors ... — The aim of this review is to provide an updated analysis of the pharmacokinetics, pharmacodynamics, efficacy and safety profile of SGLT2 inhibitors in patients with mild to moderate CKD, with a special focus on dapagliflozin , canagliflozin , empagliflozin and ipragliflozin . Tofogliflozin and luseogliflozin (only commercialized in Japan) will
[206] A Brief Review of Diagnostic Techniques and Clinical Management in ... — The diagnostic landscape is evolving, with new biomarkers like UACR, KIM-1, and NGAL supplanting traditional markers and advanced imaging techniques, providing valuable insights into kidney health. Pharmaceutical therapies, lifestyle adjustments, and the promise of precision medicine tailored to individual profiles all contribute to CKD management.
[207] What Types of Diagnostic Tests are Commonly Used? — Common diagnostic tests include: - Blood Tests: To check for infections, glucose levels, and other markers. - Imaging Studies: Such as X-rays, CT scans, and MRIs to visualize internal structures. - Urinalysis: To detect urinary tract infections or kidney problems. - Electrocardiograms (ECGs): To monitor heart activity.
[210] Renal Biopsy for Diagnosis in Kidney Disease: Indication, Technique ... — Classic indications for biopsy of the patient’s own kidney include new-onset nephrotic syndrome in adults, evidence of proteinuria greater than 1–2 g/24 h with or without hypertension, and impaired renal function of unknown cause, especially when an active urine sediment indicates possible crescentic glomerulonephritis. 3.Corapi K.M., Chen J.L., Balk E.M., Gordon C.E. Bleeding complications of native kidney biopsy: A systematic review and meta-analysis. 27.Bajema I.M., Hagen E.C., Hermans J., Noël L.H., Waldherr R., Ferrario F., Van Der Woude F.J., Bruijn J.A. Kidney biopsy as a predictor for renal outcome in ANCA-associated necrotizing glomerulonephritis. 97.Waldo B., Korbet S.M., Freimanis M.G., Lewis E.J. The value of post-biopsy ultrasound in predicting complications after percutaneous renal biopsy of native kidneys.
[211] Ultrasound elastography in chronic kidney disease: a ... - Springer — Ultrasound elastography (USE) is a noninvasive technique for assessing tissue elasticity, and its application in nephrology has aroused growing interest in recent years. The purpose of this article is to systematically review the clinical application of USE in patients with chronic kidney disease (CKD), including native and transplanted kidneys, and quantitatively investigate differences in
[212] Shear wave elastography in chronic kidney disease: a pilot experience ... — Background There currently is a need for a non-invasive measure of renal fibrosis. We aim to explore whether shear wave elastography (SWE)-derived estimates of tissue stiffness may serve as a non-invasive biomarker that can distinguish normal and abnormal renal parenchymal tissue. Methods Participants with CKD (by estimated GFR) and healthy volunteers underwent SWE. Renal elasticity was
[213] Shear wave elastography: usefulness in chronic kidney disease — Chronic kidney disease (CKD) is recognized as a major worldwide health problem. For all CKD, intra-renal fibrosis is a final common pathway that can be correlated with disease severity. Tissue stiffness can be measured non-invasively using shear wave elastography.
[214] A Comprehensive Review of Biomarkers for Chronic Kidney Disease in ... — Emerging biomarkers such as NGAL, KIM-1, and liver-type fatty acid-binding protein (L-FABP) have been linked to kidney damage, disease severity, and progression . In cancer diagnostics, recent trends include the development of novel multiplexed and integrated platforms that offer accurate and easy readouts, facilitating early cancer diagnosis
[215] Biomarkers For Predicting Outcomes in Chronic Kidney Disease — Current biomarkers for chronic kidney disease (CKD) are limited by lack of sensitivity and inability to prognosticate CKD progression. ... "Emerging" biomarkers have been examined in multiple studies, and have been validated independently in separate cohorts, whereas "novel" biomarkers may show an association in single or a few
[216] Top Kidney Function Tests: Procedures & Results Explained — Modern laboratory techniques now allow for more precise assessments, making these tests indispensable for monitoring kidney health in individuals with conditions such as diabetes, high blood pressure, and urinary tract infections. ... can impact kidney function. Testing ensures these medications are not causing harm to the kidneys. Guiding
[217] Standardization of serum creatinine and estimated GFR in the Kidney ... — Calibration of KEEP creatinine measurements had a greater impact on the current laboratory than on the laboratory previously used. The calibration process has worked to decrease overestimation of eGFR at the high range and decrease misclassification bias. ... Clinical Laboratory Techniques / methods ... Kidney Function Tests / methods
[218] Beyond creatinine: New methods to measure renal function? — This review revisits the benefits and limitations of serum creatinine, explores other kidney function biomarkers such as Cystatin C and ProEnkephalin, and examines traditional gold-standard techniques, including creatinine clearance, radioisotopes, and inulin clearance. Glomerular filtration rate (GFR), the volume of plasma water filtered by the glomeruli per unit time, serves as the critical diagnostic measure of renal function and remains the hallmark measure for identifying and monitoring kidney disease. Building upon the exploration of novel biomarkers like Cystatin C and PENK, which aim to address the limitations of traditional renal function assessment, it is essential to revisit established methods of measuring kidney function.
[219] Beyond creatinine: New methods to measure renal function? — In conclusion, the next generation of renal function tests represents a paradigm shift in medicine, nephrology, and critical care, offering improved precision, real-time monitoring, and greater applicability across patient populations.
[225] Comparison of computed tomography (CT), magnetic resonance imaging (MRI ... — Purpose: To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome. Materials and methods: A total of 255 patients with a single unclear renal mass with initial imaging studies between 2005 and 2015 were included.
[226] Comparison of 16-MDCT and MRI for Characterization of Kidney Lesions - AJR — The widespread use of sonography, CT, and MRI in the field of abdominal imaging has led to an increase in the incidental detection of renal lesions, which require further diagnostic evaluation [].This evaluation is most often done with CT or MRI, both of which are well-established techniques in the field of renal imaging [1-5].Although CT is the preferred technique because of availability
[228] PDF — The diagnostic performance of CT and MRI in detecting RCC was evaluated. MRI demonstrated higher sensitivity (90.0%) compared to CT scan (70.0%), indicating its superior ability to correctly identify RCC cases. However, CT scan showed higher specificity (87.5%) than MRI (67.5%), suggesting it was more accurate in
[230] A Brief Review of Diagnostic Techniques and Clinical Management in ... — Keywords: clinical management, ckd, lifestyle modifications, pharmacological interventions, imaging modalities, biomarkers, diagnostic techniques, chronic kidney disease To find relevant papers, search terms such as "chronic kidney disease," "CKD," "diagnostic techniques," "clinical management," "biomarkers," "imaging modalities," "pharmacological interventions," and "lifestyle modifications" were employed. Traditional indicators are essential in detecting CKD because they provide important information about kidney function and disease progression. BUN: blood urea nitrogen; eGFR: estimated glomerular filtration rate; CBC: complete blood count; ACR: albumin-to-creatinine ratio; CT: computed tomography; MRI: magnetic resonance imaging; CKD: chronic kidney disease; KDIGO: Kidney Disease Improving Global Outcomes 32.Detection of chronic kidney disease with creatinine, cystatin C, and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality.
[231] Laboratory Tests in Nephrology - SpringerLink — Nephrology is a very numerate speciality; not only is much of diagnosis based on tests, but monitoring of disease and response of laboratory tests to treatment is critical to patient management. The introduction of algorithms for the diagnosis of AKI is a prime example of the importance trends in renal tests but also the tip of the iceberg in
[235] Biomarkers in chronic kidney disease: a review — Recent renal biomarkers discovered include neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and liver-type fatty acid-binding protein. Although none are ready for use in clinical practice, it is timely to review the role of such biomarkers in predicting CKD progression and/or CVD risk in CKD.
[251] Shared Decision-Making and Patient Communication in Nephrology Practice — Shared decision-making (SDM) is the standard of care for patient or surrogates and their clinicians to arrive at a medical decision. Evidence suggests that SDM increases patients' understanding of their illness and satisfaction with their decision-making process. Dialysis patients often report the perception that they were passive participants in the decision to start dialysis, suggesting
[252] Patient-Centered Care in Nephrology Kidney Disease Management — Patient-Centered Care in Nephrology Kidney Disease Management A shift in focus moves from a disease-centered model to a patient-centered one, allowing space for active participation and collaboration with the patient by health care professionals. Every patient’s experience with kidney disease is different — and so should be their care. Patient-centered care is a philosophy that engages patients by making them feel valued, empowered, and engaged in their health journey. Through individualized care plans, patient education, shared decision-making, and holistic support, nephrology can then transcend traditional boundaries to provide the best possible treatment outcomes and quality of life for kidney disease patients. Mental Health in Dialysis Patients: Understanding the Psychological Impact of Chronic Kidney Disease and Dialysis
[253] PDF — • Shared decision-making: Collaborative decision-making involves engaging patients in discussions about their treatment options, risks, and benefits. By empowering patients to actively participate in decisions regarding their care, healthcare providers can ensure that interventions align with the patient's preferences and priorities.
[254] PDF — Benefits of patient-centered care in interventional nephrology Improved treatment adherence • Enhanced patient engagement: atient- P centered care encourages active participation in treatment decisions, fostering a sense of ownership and responsibility for health outcomes.
[255] Living Well with Kidney Disease by Patient and Care-Partner Empowerment ... — Effective strategies to empower patients and their care-partners strive to pursue the overarching goal of minimizing the burden of CKD-related symptoms in order to enhance patient satisfaction, health-related quality of life, and life participation.
[261] The psychosocial needs of patients who have chronic kidney disease ... — | Honouring the patients’ need for control | At times, patients felt like they lacked control of their illness and treatment, creating a feeling of helplessness | Feeling listened to, educated on their treatment and addressing symptoms using psychosocial support could foster self-efficacy | | Moderate confidence | Minor concerns regarding methodological limitations, coherence, adequacy and relevance | “If I’m going to feel this bad for the rest of my life, do I just want to end it now?” Thematic synthesis of seven studies identified five themes: addressing the patient’s CKD-related educational needs, supporting the patient’s relationships, honouring the patient’s need for control, adjusting to change, and recognising fear of treatment and disease.
[263] Effect of psychosocial interventions for depression in adults with ... — Psychosocial interventions may help reduce distressing symptoms, increase coping strategies, increase social connectedness, assist in strategies to address specific disease-related problems, and decrease anxiety and stress . However, there is currently no uniform treatment standard and way for psychotherapy.
[265] Personalized Medicine in Kidney Disease - PMC — A tailored approach for hypertensive kidney disease involves thus treatment strategies addressing the underlying causes, individual characteristics, and specific needs of each patient.
[266] Chronic Kidney Disease Management Guide Template — It involves various aspects such as medication management, dietary guidelines, and regular monitoring. Our Chronic Kidney Disease Care Plan template provides a structured framework to ensure all crucial elements of CKD management are addressed for each individual patient.
[267] Best-Laid Plans: Can a "Life-Plan" Improve the Concordance of Kidney ... — The ESKD Life-Plan promotes shared decision-making (SDM) among patients and their dialysis care team as they strategize treatment plans for a lifetime with kidney disease and "specifically considers the patients' current medical situation, current and future life goals, preferences, social support, functional status, and logistics and other
[270] The impact of nurse-led care in chronic kidney disease management: a ... — The impact of nurse-led care in chronic kidney disease management: a systematic review and meta-analysis - PMC The impact of nurse-led care in chronic kidney disease management: a systematic review and meta-analysis Although a great deal of evidence supports the effectiveness of nurse-led care in improving quality of life, sleep, pain, overall health and depressive symptoms among CKD patients. Effects of post-discharge nurse-led telephone supportive care for patients with chronic kidney disease undergoing peritoneal dialysis in China: a randomized controlled trial. The Efficacy of a Nurse-Led Disease Management Program in Improving the Quality of Life for Patients with Chronic Kidney Disease: A Meta-Analysis.
[271] Chronic kidney disease management | Nursing in Practice — Chronic kidney disease is defined as irreversible kidney damage leading to structural abnormality with proteinuria and/or haematuria, and/or glomerular filtration rate (GFR) <60ml/min/1.73m².1 Glomerular filtration rate describes the flow rate of filtered fluid through the kidneys and is considered an accurate measure of overall kidney
[273] Exploring the care experiences of hemodialysis nurses: from the ... — Culturally sensitive care has been identified as a best-practice approach for improving health outcomes. Hemodialysis patients require culturally sensitive care because it involves totally changing their previous life. ... and practices are an important part of holistic nursing care . ... Nephrology nurses should establish culturally sensitive
[275] Chronic Kidney Disease Patient Education: A Powerful Tool to Help ... — CKD health education can help make each one of those interventions more effective by empowering patients to take control of their health and, in turn, improving patient outcomes and quality of life. Chronic kidney disease patient education includes programs, resources, and activities designed to help people with kidney disease make informed
[276] Kidney Disease Patient Education | Interwell Learning — Interwell Learning provides the only reimbursable* kidney disease education (KDE) series for patients that combines bilingual video content, one-on-one sessions with a clinical educator, printed materials, and more! ... "Metrolina Nephrology implemented Raenali education, now Interwell Learning, in early 2022 and it has been well received by
[277] CKD Patient Engagement and Education | National Kidney Foundation — Image NKF Patient Journey Answer a few questions and we will provide you with information about your kidney health. Image Nutrition Your home for resources on eating with kidney disease or to care for your overall kidney health. Image Impact Patient-Centered Research Kidney Research Connect matches you with research projects based on your connection to kidney disease. Image NKF Cares Offering support for people affected by kidney disease, organ donation, or transplantation. Image NKF Peers Where kidney patients are connected with trained mentors who have been there themselves. Image Resources & Get Involved Get connected with others who have donated a kidney. Image Spring Clinical Meetings NKF’s premiere educational event for the interprofessional kidney health team.
[289] Nephrology - JAMA Network — Explore the latest in nephrology, including recent guidelines and advances in the prevention and management of acute kidney injury and CKD.
[290] Embracing the Generational Opportunity to Improve the Care of Kidney ... — More recent advances in diabetic kidney disease resulting from use of the non-steroidal mineralocorticoid receptor antagonist finerenone 19 and the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide 20 have further energized us and are likely to afford substantial incremental benefits to patients already treated with ACE inhibitors or
[293] Novel strategies in nephrology: what to expect from the future? — In this review, we aim to describe the novel diagnostic methods in nephrology such as the advancements in kidney imaging and modalities utilized to estimate renal function as well as the novel therapeutic approaches in kidney disease including wearable artificial kidneys, xenotransplantation, stem cell-derived therapies, bioengineering models
[296] Promising novel therapeutic targets for kidney disease: Emphasis on ... — Volume 28, Issue 2, February 2023, 103466. Post-screen. Promising novel therapeutic targets for kidney disease: Emphasis on kidney-specific proteins. ... it is essential that research be carried out on novel therapeutic targets that specifically target kidney proteins, such that a distinct and desired improvement is seen in the prognosis for
[298] Personalized Medicine in Kidney Disease - PMC — In particular, personalized medicine approaches in chronic kidney disease (CKD) aim to tailor treatment strategies based on underlying causes, genetic factors, the rate of disease progression, and other personalized factors. CKD can arise through various pathological mechanisms, and it is not an infrequent result of acute renal injury (AKI).
[301] Innovations in Wearable and Implantable Artificial Kidneys — a supply can be carried with the patient. Wearable Artificial Kidney The WAK (Wearable Artificial Organs Inc) is a wearable blood-based renal replacement device (schematic in Fig 2). It is battery operated, weighs < 5 kg, and is presently worn like a belt or a vest. The WAK system removes barriers to home HD related to electricity and water
[302] Wearable and implantable artificial kidney devices for end-stage kidney ... — Observation: Researchers from different fields of artificial organs collaborate to overcome the challenges of creating products such as Wearable and/or Implantable Artificial Kidneys capable of providing long-term effective physiologic kidney functions such as removal of uremic toxins, electrolyte homeostasis, and fluid regulation. A focus
[303] What Is a Wearable Artificial Kidney? - iCliniq — A wearable artificial kidney is a device used to provide continuous renal replacement therapy for end-stage renal disease. ... the wearable artificial kidney also faces several challenges that must be addressed before widespread adoption can occur, which include- ... Patient Acceptance and Education - Patients and healthcare providers need to
[304] Wearable artificial kidney: problems, progress and prospects — Ultimately, safety and user acceptance will be crucial for the transformative adoption of a wearable artificial kidney. For an ambulatory patient in the real world, safe blood access, inhibition
[305] Preserve Equitable Access to Critical Medication | Kidney Care Equity — Americans on dialysis need help from Congress to ensure they have access to much needed innovative treatments. More than 100 stakeholders from patient advocacy groups, racial equity organizations, labor unions, and faith leaders wrote to Congress urging passage of the Kidney PATIENT Act ( H.R. 5074 / S.4510 ) this year.
[306] KIDNEY EQUITY FOR ALL - National Kidney Foundation — The National Kidney Foundation (NKF) is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. As impassioned stewards and leaders in kidney care, we are devoted to bringing fair, equitable, and innovative treatment