Editorials
Treatment of Diabetic Nephropathy: Changing Landscapes and New Horizons
Until the early 19th century, diabetes mellitus (DM) was regarded as a disease of the kidney, in which one of the signs was that of an increase in the volume of urine and wasting. Only after the identification of glucose in blood and urine in the late 18th century was it recognized as a metabolic disorder. It was noted in parallel that patients with DM may show presence of coagulable urine containing albumin as a sign of kidney disease. After the advent of availability of insulin in the early 1920s, which led to increased survival, diabetic nephropathy became more apparent.A New Therapeutic Era in the Management of Diabetic Kidney Disease
Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease (ESKD) worldwide. After 2 decades of negative trials, in the last few years there has been a major and welcome shift in the therapeutic options to treat DKD. Nephrologists will be in the forefront of implementation of these new therapies as well as in the education of their colleagues and patients on the benefits and possible side effects of these novel therapies.The Ultrasound-Augmented Physical Exam for Nephrologists: Beyond the Kidney
Recent developments in handheld ultrasound technology, including cloud-based image archiving, artificial intelligence–enhanced image guidance, and the development of the capacitive micromachined ultrasound transducer—a microchip alternative to conventional piezoelectrics—are driving down the cost of ultrasound devices and facilitating image acquisition for novice learners. These technologic adaptations lower the barrier for entry and accelerate an already burgeoning trend of adoption of point-of-care ultrasound (POCUS) among medical providers.Home Hemodialysis
This special issue of ACKD on home hemodialysis (HHD) represents a timely reflection on the state of HHD in the United States. President Trump's executive order of July 2019 (Advancing American Kidney Health Initiative) laid out an ambitious agenda for expanding the use of home dialysis and preemptive kidney transplantation in the United States. This issue is a compendium of articles that are wide in their breadth and scope, representing an attempt to address a variety of issues involved in implementing such a complex and difficult task.Dialysis: Please Try This at Home!
Yes, in 2021, we are able to say that the quality of life and freedom to do the things we love can be possible while on dialysis. A special mention to the photograph on the cover of this issue dedicated to home hemodialysis (see credits in the issue), which exemplifies that.Nephrology Critical Care: A Darwinian Evolution
While hospitals across the nation continue to expand their capacity to care for critically ill patients, the practice of medicine in the intensive care unit (ICU) has evolved from being solo intensivist-driven to a multidisciplinary care model. The latter involves a myriad of clinicians as well as pharmacists, physical therapists, nutritionists, and subspecialists that usher a diverse and complementary expertise.1 Among many subspecialists in the ICU, the nephrologist serves as an invaluable asset in many commonly encountered conditions, including electrolyte/acid-base derangements and most notably acute kidney injury (AKI).COVID-19 and the Kidney Community: Coalescing in Crisis
The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes to the practice of kidney medicine. The ability to provide acute dialysis is strained due to high rates of acute kidney injury (AKI), which occurs in up to 30% to 40% of hospitalized patients. The presence of AKI in the setting of COVID-19 is associated with high morbidity and mortality.1 Figure 1 illustrates various manifestations of COVID-19 in the kidney. The need for social distancing has resulted in a shift to outpatient telemedicine for many patients with kidney disease.
