Herbal agents are used on a daily basis by many. Risks to the kidney have been identified with some of these agents. Here is a brief concept map of few of the agents have had strong associations with CKD, glomerular disease and electrolyte disorders. Dr Warren Kupin from Miami recently spoke to us about these and I summarize these from his discussion to us.
Looking back at the year 2014, where do we stand in terms of
to last year, this year bought a spectrum of kidney diseases to light and the
number of articles published in high impact journals was astounding. NEJM and
JAMA had great articles from amazing clinical research done this year in
Nephrology. There has been no research
done in hyperkalemia in decades, but of recent, 3 top tier articles with 2
new agents in NEJM
and JAMA. And if you look by category- nephrology in NEJM, this year had 13
original articles, up from 10 in 2013. There was significant review articles as
well in NEJM this year on various topics.
and CORAL trial being
some of the major Hypertension highlights but the JNCVIII also made way to affect
the world of Nephrology. The science of nephrology is clearly advancing. Even though some of the trials were negative
trials, we know what DOES NOT work and keep trying rather than doing something based
on observational data and then finding out it caused harm. The renal fellow network has a top 10 nephrology
story countdown. Go and vote for your top study. The
new allocation system for transplantation is a positive step for clinical
patient care in nephrology.
realm of education, Nephmadness
2014 ( brainchild of Topf and
Sparks) was well received with much more participation then 2013 version. Watch out for the upcoming Nephmadness 2015
this upcoming year.
we look into 2015, think positive and let’s create the same magic as we did in
2014 for science in nephrology. Every field has their bumps and so does
nephrology. We shall overcome this barrier as a community as well. Collectively, we need to inspire students,
residents at ground level and every institution needs to light this candle. No
large society can make this happen. Even if one person at each institution can
inspire students and resident, we will make it happen. This is a collectively call for all academic,
and private practice nephrologists who love what they do to shed their
experience and passion to trainees. For
those who don’t like what they do- I have no comments but to ask yourself why
you went into it for the first place?
APOL1 gene nephropathy has now emerged as a potential new entity given the linkage to African American ancestry and having these alleles that were protective against sleeping sickness and then leading to more HTN proteinuric and non proteinuric renal disease in AA. Below is a summary concept map on this topic and how having these alleles and then a SECOND HIT concept might be necessary for disease phenotype. There are likely two disease phenotypes- FSGS variants and then the tubular non proteinuric variants. African Americans with arterionephrosclerosis who possess two APOL1 risk
variants more often lack obsolescent glomerulosclerosis and have greater degrees
of (solidified and disappearing) glomerulosclerosis, thyroidization-type tubular
atrophy, and microcystic tubular dilation than patients with fewer than two risk
variants in the non proteinuric patient lists. Also, there is some emerging data that JC and BK virus might be protective for the kidney relatives of patients with APOL1 nephropathy.