Concept Map: Onco-HTN( cancer therapy related HTN)

 

Based on a recent AHA scientific statement, a concept map on onco-HTN

NELL-1 Membranous Nephropathy- Concept Map

 

This is an inspired figure from Sethi's amazing review in CKJ. 

This figure is a summary of the various secondary causes of NELL-1 MN that have been described. 
( keeping in mind that primary NELL-1 MN without a secondary cause still is the most common)

Concept Maps: Bone disease, FGF-23 and more..

 

references

https://www.kidney-international.org/article/S0085-2538(15)54255-5/fulltext

https://jasn.asnjournals.org/content/18/3/875

Special post by 

Lakshmi Kannan, MBBS, MD, 

Department of Nephrology, Pikeville Medical Center

Adjunct Faculty, University of Pikeville Kentucky College of Osteopathic Medicine

Kentucky, USA

Consult Rounds: Differential Diagnosis of Asterixis

 The differential diagnosis of asterixis is important for a Nephrologists- It is not always Uremia...

Metabolic causes-- Uremia, Liver failure and hypercapnia 
Neuro drugs--Anticonvulsants, Benzos-- classic is phenytoin, carbamazepine, gabapentin, valproic acid, lithium
Antibiotics-- Cefepime, and other cephalosporins
Electrolyte disorders-- Hypomagnesemia, hypokalemia( never seen it there)
Bilateral brain lesions
**Unilateral brain lesions cause unilateral asterixis

Detective Nephron: Next Venture

 Here is another mystery electrolyte disorder with Detective Nephron

https://www.kidneynews.org/view/journals/kidney-news/14/12/article-p16_12.xml 

Concept Map: Acute Pancreatitis and AKI

 

Special post by 

Lakshmi Kannan, MBBS, MD, 

Department of Nephrology, Pikeville Medical Center

Adjunct Faculty, University of Pikeville Kentucky College of Osteopathic Medicine

Kentucky, USA

Reference is here

Perspective: Interim report of ASN Task Force for Future of Nephrology 2022

 The ASN task force on the Future of Nephrology 2022 put out 10 important pointers for fellowship training. Here are the 10 pointers with my opinion on each next to it.

1. Enhance competency based Nephrology education: This is in line similar to COCATs in cardiology. 
I think this is a very important move as this will let us focus on the core topics in General Nephrology training. Overall, this is a win win for both fellows and programs

2. Individualize pathways for career goals: This is basically asking to create tracks so that each fellow can create a career niche. After basic general nephrology training, allow for time spent in various sub fields within nephrology( not an extra year of training). 
Personally, I am all for this one and have been promoting this at our center for last 6 years. This allows for selection of tracks and focus for each fellow. It makes their fellowship unique from the peers. Focused tracks can make this happen. At our center we do the following tracks and give a certificate for each graduate. But each track has requirements they have to fulfil under a small curriculum within a curriculum.  Yes, its time to just be creative over and over. 

3. Reconsider procedural training in Nephrology. Emphasis on removal of potentially placing of lines and performance of kidney biopsies. Instead, there should be focus on indications, knowledge of complications and if someone desires( individualized training), program should be able to offer the training. Emphasis on POCUS was mentioned.
This is the final straw for our procedures in nephrology but if you ask the fellows- most don't do it anyway post graduation- Its time for it to go. Smart Move by ASN. I don't think it should be required for ACGME and board exam to have done these procedures. Good focus on POCUS as we embrace the future. This is a win for fellows but not sure if a complete win for programs. Not all programs have faculty to teach POCUS. We need more faculty trained in POCUS to make this happen. Glad I learnt it from my fellow many years ago- truly has changed my practice.

4. Emphasize training in home therapies- Need more intensive training in PD and HHD.
This is a MUST for all. I think this is important for our patients and our trainees. A win for the fellows. Not a sure win for all programs as some programs may suffer due to lack of patients -- not their fault as its a system's problem at some centers. But this may raise the bar to make sure there is enough faculty who are comfortable to teach PD and HHD and enough volume. Not sure you need a third year for this but rather most fellows graduating should be able to comfortable prescribing and managing PD and HHD. Some fellows who want an academic career may want an extra year of training at specialized centers. 

5.Close gaps in current nephrology training. If there were gaps from the above 4 points, programs may need to partner with other societies to close those gaps.
I think this is a temporary solution. Eventually, this will evolve as most programs close the gaps

6. Promote well being of nephrology fellows. 
This was important and finally made it to a priority. This will help with burnout in our fellows. Working with NP/PA and restructuring programs will help with this matter. We must not forget our faculty and attending well being as we work on fellows well being. Neither should suffer.

7. Prioritize diversity, equity, inclusion and health care justice
I think this is extremely important. We need more diverse applicants and applicant pool in Nephrology. Diversity brings ideas and promotion of our field forward. 

8. Foster interprofessional practice.
This is important and our recent ASN Kidney News sept 2022 issue really highlights this. We are a kidney care team- all should work together. 

9. Ensure interdisciplinary practice. Working closely with cardiology, oncology, hepatology and other fields in medicine is critical for our training. 
This is a given but almost forgotten. Working with our colleagues closely will be important to foster collaboration and programs to help trainees for both sides. A classic example of this is centers that have created nephro-hospitalists,  cardio-renal services etc. 

10. Inspire lifelong learning
This is aspirational. This may happen but may not happen. This is individualized but if the program can create venues, programs to continue ongoing learning- this would be very helpful. 

Overall, I applaud the entire ASN workgroup on this venture!