Editorials
Advances in Chronic Kidney Disease as Syntopicon
Advances in Chronic Kidney Disease began its life under the aegis of Allen R. Nissenson as the first Editor-in-Chief of Advances in Renal Replacement Therapy.1 Dr. Nissenson's expressed desire was for A-R-R-T to become the “art” of renal replacement therapy. He explicitly stated this aspiration, echoing the enthusiastic prose of Dr. Seuss, in his inaugural editorial in April 1994, “The ARRT of Uremia Therapy.”1 Instrumental to the journal's conception was much the effort of Garabed Eknoyan—a long-time advisor-contributor to the National Kidney Foundation in so many ways.Lupus Nephritis: Breaking the Lull
Systemic lupus erythematosus (SLE) has a prevalence of 241 per 100,000 people in the United States.1 Young women are disproportionately affected and disease burden is highest in blacks and lowest in whites in studies that report data by race.1 Up to 75% of SLE patients will develop kidney disease, which is often asymptomatic and detected only by urinalysis. Pathologic classification of lupus nephritis (LN) is based on the location and degree of glomerular involvement coupled with the activity and chronicity of histologic changes.Erythropoiesis-Stimulating Agents and Cancer: Myth or Truth
Erythropoiesis-stimulating agents (ESAs) have been implicated in causing cancer progression. This belief has been largely based on trials in the early 2000s of ESA use in malignancy with high hemoglobin (Hgb) targets and large ESA doses to attain the targets. More recent trials using ESA doses with Hgb targets similar to current goal levels in CKD have not confirmed this increased risk of cancer progression for most malignancies.Eradicating the Viral Triad in Hemodialysis Units
In this issue of Advances in Chronic Kidney Diseases, Dr James Novak as Guest Editor has curated a collection of manuscripts from a cadre of nephrologists whose curiosity includes the viral nephropathies. The authors present a well-researched group of articles that comprehensively review the vast majority of contemporary viral disorders with which most nephrologists will engage at some point in their careers. However, the bulk of nephrologists will be concerned with 3 viruses more than others, hepatitis C virus (HCV), hepatitis B virus (HBV), and the human immunodeficiency virus-1 (HIV).Dr. Conn Lives on: Insights Into Screening and Genetics of Primary Aldosteronism
This issue of Advances in Chronic Kidney Disease features an old standard, hypertension. This topic is reviewed periodically. This time, Dr. Kausik Umanath has taken up the gauntlet to press forward our collective mission to diagnose and treat this most fundamental medical problem early, accurately, and efficiently. In this issue, the variegation of the pathophysiology of hypertension will be revealed along with its treatments. In Dr. Umanath's Guest Editorial, you will see a glimpse of what is contained within, but first, a story.Hemodialysis Catheter Device Protection: Damned if We Do; Patients Are Damned if We Don't
In this issue of Advances in Chronic Kidney Disease, Guest Editor Mohanram Narayanan, MD, reinvigorates the prior theme of infections in kidney patients. Infections are frequent in nephrology patients and often deadly. Each of Dr. Narayanan's authors pointedly contributes his/her wisdom to the infection theme. So, before reading more, please read each article carefully to enhance your practical working knowledge on behalf of your patients.Leadership as Tribal Leader
In this final 2018 issue of Advances in Chronic Kidney Disease, our Guest Editor Rebecca Schmidt takes the lead on leadership. She has compiled a series of articles that compress 2 important and sometimes nebulous concepts into digestible format with the assistance of her contributing authors. Each article adds to the others to provide a roadmap to establishing a successful career in medicine and specifically nephrology.A Tale of Two Failures: A Guide to Shared Decision-Making for Heart and Renal Failure
Heart failure and kidney disease are common and rapidly growing conditions in the United States. It is estimated that there are currently 6.5 million adults in the United States1 and 23 million adults worldwide who suffer from heart failure.2 Approximately 30 million Americans have evidence of chronic kidney disease (CKD).3 The presence of either condition is associated with a higher morbidity and mortality than the general population. Approximately 40% of patients with end-stage renal disease (ESRD) have heart failure.It Is Really Time for Ammonium Measurement
In this issue of Advances in CKD, Guest Editors, Jose A. Arruda and Daniel Batlle, have assembled an A-list of clinician-scientists to review the old and new concepts of renal tubular acidosis (RTA). In an era in which dialysis and CKD dominate nephrology clinical practice, is it not nice to encounter something different every now and then? A low-serum venous total CO2 (referred to as bicarbonate, hereafter), of which the etiology is not readily apparent, is one of the many respites for acid-base mavens of nephrology.Diabetes and the Kidney: Sweet Dreams
A spoonful of sugar makes the medicine go down. —Robert B. Sherman, Richard M. Sherman; 1964 With apologies to Julie Andrews, a spoonful of sugar might be considered child abuse in this modern era of diabetes and obesity. As of 2015, more than 700 million adults worldwide have diabetes or impaired glucose tolerance, and about half of these are unaware of the diagnosis.1 Almost certainly, the glut of type 2 diabetes has been fueled by the expanding obesity epidemic (pun intended). In the United States, the prevalence of obesity tripled from 13% in 1960 to 38% in 2014.Hyperkalemia: Inpatient PaniK
In this issue, Guest Editor Jeffrey Kraut determined to “go back to the basics” of nephrology and assembled an august group of authors whose expertise spans the gamut of electrolytes and acid-base disorders. The table of contents represents a carefully curated compilation of articles, each of which is a minireview and state-of-the-art appraisal of the literature on a particular topic. In alignment with this familiar group of topics, I have chosen to concentrate on inpatient hyperkalemia. Rather than opining on the panoply of potassium abundance disorders, I devote my time and yours to matters of all things done wrong when confronted with inpatient hyperkalemia, a common finding that evokes a “PaniK” disorder.The AKI Clinic for Fragile Patients
The recent terrorist attack in Manchester, England, at a pop “musical” concert1 represents a somber reminder of the London Blitz—the “lightning war”—prosecuted by Hitler against Great Britain during World War II. The dome of the church on the cover illustration, provided by Guest Editor, Charuhas Thakar, represents the hope of the Londoners who survived the protracted bombing that lasted 9 months, and our own hope that an effective resolution to the abject, lawless acts of violence by fanatical and radical terrorists comes soon.Prophylactic Hemodialysis for Protection Against Gadolinium-Induced Nephrogenic Systemic Fibrosis: A Doll's House
No doubt you, like I, have been informed by your radiologist that your advanced CKD or ESRD patient “must undergo hemodialysis” to prevent gadolinium-based contrast agent (GBCA)-induced nephrogenic systemic fibrosis (NSF) following a magnetic resonance imaging (MRI) study. Few disorders in nephrology have generated more excitement and fear than this devastating dermatologic disorder, first described in 2001 as a case series of 13 patients originally discovered in 1997 at the Sharp Clinic.1 This disfiguring and disabling skin-scarring disorder, formerly labeled as nephrogenic fibrosing dermopathy, is attributed to the deposition of gadolinium chelates in the skin and other organs, hence, the “systemic” term.The Tubulointerstitium: Dark Matter
Relegated to a less glamorous position than the glomerulonephritides, the tubulointerstitial compartment or tubulointerstitium of the kidney has been the dark matter of the kidney universe.1 In the same fashion that dark matter predominates over atomic matter, the tubulointerstitium does so over the glomerular compartment. In fact, dark matter and the tubulointerstitium hold their respective universes together. In this issue, some of the mysteries of kidney dark matter are revealed by Cynthia Nast and the authors she has enlisted.Nephrology and Telehealth: Now? or Now!
In this issue of Advances in Chronic Kidney Disease, Clarissa Diamantidis, Andrew Narva, and colleagues provide examples of telehealth within the field of nephrology that are actively utilized today. They also offer descriptions of real-world approaches to the development and sustainability of such telehealth programs.One Isn't the Loneliest of Numbers: N-of-1 Trials
In this issue of Advances in Chronic Kidney Disease by Guest Editors, Donald Molony and Joshua Samuels, evidence-based medicine (EBM) once again comes to the fore. This issue represents an encore of sorts, reinvigorating many of the concepts which they promoted with their authors in Volume 19, Issue 1 of this journal, “Evidence-Based Nephrology.”Improving Transitions in CKD: Failure Mode
In this issue of ACKD, Maria DeVita with her collaborators summarize the important points to consider as patients transition from Stage 4 to Stage 5 CKD. The earlier transition from Stage 3A to Stage 3B portends enhanced cardiovascular risk, and these heart and vascular risks and overall mortality increase exponentially through Stages 4 and 5.1,2 The importance of safe navigation through the course of Stage 4 cannot be overemphasized. This is particularly relevant in terms of patient education and modality of renal replacement therapy.Intensive Care Unit Renal Replacement Therapy: Less Is More (or Better)
Acute kidney injury (AKI) is on every nephrologist's mind. Although it took some time for the transition to the nomenclature of CKD stages from chronic kidney failure, the rapid assimilation of “AKI” into the internal medicine vernacular has been relatively light speed. Now, AKI must be considered a cause of CKD, although not necessarily in the fashion of a 5/6 nephrectomy—an immediate cause of CKD that is accompanied by a tremendous degree of compensatory hypertrophy unseen in the human analogue.PGX: Pharmacogenomics During Generation X
Years ago, a pharmacologist informed a group of physicians treating high blood pressure that a great deal of time was spent treating patients with hydralazine who would not respond to it. He stated that a hydralazine test dose of 10 mg would resolve the issue for many. No blood pressure–lowering response from that dose would predict an equally impotent result from the ensuing and multiple, relatively slow dose escalations—the wont of most treating individuals. Consciously or not, the pharmacologist was stating that the relationship between a drug and its efficacy, which represented the culmination of multiple metabolic and biologic factors, lay in the genes.Geriatric CKD: Value-Based Nephrology
Each nephrologist in the United States is now participating in a value-based purchasing (VBP) plan. Nephrology patients, particularly geriatric individuals with advanced CKD or ESRD represent the bulk of our current and future VBP-based decision-making. Therefore, nephrologists must become more adept at value-based decision-making, and these decisions must align with the values of patients.Vascular Access: Inukshuk
An inukshuk (pl. inuksuit) is a figure constructed from unworked stones or boulders (Fig 1) that is used for communication among the Inuit in the Arctic.1 In Inuktitut, the language of the Inuit, inukshuk means “to act in the capacity of a human.” Inuksuit serve several functions including acting as hunting and navigational aids, coordination points, and messaging centers. In addition to their practical functions, inuksuit are venerated and possess spiritual connotations. For those who survive and thrive in the Arctic in the “Old Way,” mindfulness and appreciation of the import of guidepost inuksuit are critical.Hepatology and Nephrology: Nimbus
Our two Guest Editors, Jay Koyner and Michael Heung bring forth the ever-emerging issue of concurrent liver and kidney disease and those individuals with acute or chronically impaired hepatic function who develop kidney dysfunction acutely or chronically. They note that increasingly nephrologists have specialized in areas outside their usual work, for example, the onco-nephrologist. Furthermore, they discuss the nascent subspecialist, the hepato-nephrologist.Set Theory: Nephrology ∩ Urology
Each new patient encounter for me engenders 2 proclamations. The first is the formal introduction of name, and the second is to define who I am, a nephrologist, and who I am not, a urologist. The Guest Editors, Dr Hoenig, an adult nephrologist, and Dr Neu, a pediatric nephrologist, have placed us at the crossroads of Nephrology and Urology in this issue of Advances in Chronic Kidney Disease. Their intent and that of the invited authors of this review is for nephrologists to more fully acknowledge and comprehend what urologists do because some urological disorders affect the practice of Nephrology.Hypertension in CKD: Sodium Still at the Nexus
The co-editors of this issue of Advances in Chronic Kidney Disease, Drs John Sperati and Adam Whaley-Connell, have succeeded in bringing together a series of articles that comprehensively, yet concisely, describe that which is most contemporarily important in the area of secondary hypertension. Notably, this issue was purposefully placed to follow the most recent issue of Advances in Chronic Kidney Disease co-edited by Cohen, Goldman, and Sim and which focused on hypertension in general. Aldosterone, the intrarenal renin-angiotensin system, pharmacologically and inadvertently induced aggravation of high blood pressure, catecholaminergic excess, insulin resistance and diabetes, sodium and extracellular volume expansion, and cardiotonic steroids, are all discussed within the context of secondary hypertension.Ambulatory Blood Pressure Monitoring: Mercury Rising
In this issue of Advances of Chronic Kidney Disease, the 3 coeditors, Debbie Cohen, Jesse Goldman, and John Sim, have marshaled the efforts of 11 sets of authors to provide the readership with updates of the diagnosis and management of the most prevalent cardiovascular disease, hypertension. The 11 articles expansively cover the engaging and multidimensional relationship between hypertension and the kidney. However, this editorial will reflect on some of the vagaries encountered in the day-to-day practice of managing hypertension.
