Concept Map: Methotrexate Renal Toxicity

 

Picture created using biorender.com
Pathology pic obtained from google: Arkana lab collection. 

ASN Kidney News All Education Issue 2021

 July 2021 is an entire issue of ASN Kidney News. See all visual abstracts related to the issue

Opinion: Impact factors and Renal Journals( Kidney Journals or Nephrology Journals)

When we observe, no nephrology journal that published original investigations had an impact factor of >10.0 till 2021. Cardiology, Oncology and Gen Med journals top the lists usually with high impact factor in the 90s, 70s, 60s but obviously in the two digits. It is good to see finally that two of our journals KI and JASN have entered the two digits, both flagship journals of ISN and ASN. 

What is an impact factor? (IF). It is an index calculated by Clarivate that reflects the yearly avg number of citations of articles published in the last 2 years in a given journal, as indexed by the web of science. In the academic world, this matters as journals with high IF values are often deemed as more important and carry more prestige. Several promotional meetings at med schools also take this metric as the most important on where the candidate's work is published. Lower IF journals or higher IF journals

Despite it's shortcomings, IF and the author's citation index( h-index), such judgements remain common practice suggesting a need for an alternative method. Some have proposed something called the relative citation ratio( RCR).  It is an improved method to quantify the influence of a research article by making novel use of its co-citation network—that is, the other papers that appear alongside it in reference lists—to field-normalize the number of times it has been cited, generating a RCR. Since choosing to cite is the long-standing way in which scholars acknowledge the relevance of each other’s work, RCR can provide valuable supplemental information, either to decision makers at funding agencies or to others who seek to understand the relative outcomes of different groups of research investments.

One should read this interesting tweet on this topic

We have a broken system in science. Currently, the main bulwark still protecting science from total collapse in the US is the NIH scientific review system.

I know this may sound extreme. But hear me out. 1/N

— Mara Mather (@MaraMather) June 29, 2021

Also, check out this amazing post by Curry on " Sick of Impact Factor" . He says that that real problem started when IF began to be applied to papers and people. He says and I quote, 

" I can’t trace the precise origin of the growth but it has become a cancer that can no longer be ignored. The malady seems to particularly afflict researchers in science, technology and medicine who, astonishingly for a group that prizes its intelligence, have acquired a dependency on a valuation system that is grounded in falsity. We spend our lives fretting about how high an impact factor we can attach to our published research because it has become such an important determinant in the award of the grants and promotions needed to advance a career. We submit to time-wasting and demoralizing rounds of manuscript rejection, retarding the progress of science in the chase for a false measure of prestige."

Some not so perfect options/alternatives for IF are on this website.  Here is the chemistry world's revolt against it. This one study showed that an Article Influence score (AIS) and Source Normalized Impact per Paper (SNIP) were the only bibliometric alternatives to demonstrate a positive correlation when compared to the IF (r = 0.94) and (r = 0.66) respectively.

Interesting discussion on twitter on the recent announcement of renal journal IFs. 

Nephrology specific impact factors: KI 10.6, Jasn 10.1, AJKD 8.8, CJasn 8.2, NDT 5.99, clinical kidney journal 4.5, KI Reports 4.1

— Manish M Sood MD MSc FRCPC (@Msood99M) June 30, 2021

So, what should renal journals do? Should we be leaders in medicine and change the tide or try a stick with the old ways and continue using the IF? 

Concept Map- Causes of Renal Amyloidosis

 

Created using biorender.com 

Immune checkpoint inhibitors and the Kidney infographic

 

Here is a comprehensive infographic by Tejas Desai on 4 studies from around the world with ICI and the Kidney. 

Topic Discussion: SGLT2i and the Kidney

 

Post Grand Rounds SLGT2i and the Kidney Tweetorial
- The Glucoretics - thanks @edgarvlermamd @ChristosArgyrop @jam_hirsch for some slides
Start...PART 1 https://t.co/rXn5AqYinO

— Kenar Jhaveri (@kdjhaveri) May 28, 2021

SLGT2i and the Kidney Tweetorial Part 2
Start: Time to #flozinate
When prescribing- mindful for bp management https://t.co/OD5WOYOYv0 @aishaikh pic.twitter.com/PDqCo1vJK2

— Kenar Jhaveri (@kdjhaveri) May 28, 2021

Two tweetorials I had recently done on the benefits of SGLT2 inhibitors

Here is a table summary of what exists on benefits of various things in Nephrology

SGLT2i  benefit	Summary or Major Reference
Diabetic Kidney Disease	https://onlinelibrary.wiley.com/doi/full/10.1002/clc.23508
IgA Nephropathy	https://www.kidney-international.org/article/S0085-2538(21)00396-3/fulltext
SIADH	https://jasn.asnjournals.org/content/31/3/615.abstract
Hypomagnesemia	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380494/
Kidney Stones Prevention	https://link.springer.com/article/10.1007/s00125-021-05424-4
Anemia of CKD	https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30300-4/fulltext
Prevent AKI	https://cjasn.asnjournals.org/content/16/1/70.abstract
Prevention of cisplatin AKI	https://journals.physiology.org/doi/full/10.1152/ajprenal.00512.2019

 

COVID19 vaccine induced glomerular diseases?- a literature update May 2021

The vaccine for COVID19 has been a lifesaver for many around the world. As expected, as you upregulate your immune system- you are going to get some flare ups of your immune system. Thus far, what are we noticing Minimal change disease, MN and IgA nephropathy. 

Several published cases of podocytopathies- mainly minimal change disease- either de-novo or relapse have been reported ( 4 cases thus far)

https://www.kidney-international.org/article/S0085-2538(21)00493-2/fulltext (Pfizer-BioNTech )

https://www.sciencedirect.com/science/article/pii/S0272638621005096 (Pfizer-BioNTech) 

https://www.ajkd.org/article/S0272-6386(21)00602-8/fulltext ( Pfizer-BioNTech )

https://www.kidney-international.org/article/S0085-2538(21)00478-6/fulltext (Pfizer-BioNTech)

IgA nephropathy flaring up has been reported ( 3 cases thus far)

https://www.kidney-international.org/article/S0085-2538(21)00465-8/fulltext ( Moderna)

https://www.kidney-international.org/article/S0085-2538(21)00286-6/fulltext (Moderna)

Relapse of Membranous Nephropathy  ( one case)

https://www.kidney-international.org/article/S0085-2538(21)00494-4/fulltext (Sinovac’s COVID-19 vaccine.)

Acute transplant rejection has been reported

https://www.kidney-international.org/article/S0085-2538(21)00466-X/fulltext ( Pfizer-BioNTech)

While we cannot be totally sure if this is vaccine related- timing maybe a factor. I am sure there will be many more to be added to this list.

Despite this, the vaccine saves lives! Remember severe COVID19 disease led to significant AKI and ATN and even several cases of glomerular diseases. Such vaccine associated immune responses should not deter one from getting vaccinated. Overall, even the flu vaccine and other vaccines have been associated with several glomerular diseases such as MCD and membranous nephropathy.  Given mass vaccinations happening around the world, there will be cases of vaccine induced GNs( but still very very rare)