The Emerging Nephrologist: A Training Vision
Meguid El Nahas in Kidney Diseases in the Developing World and Ethnic Minorities, 2005
The Western definition of a nephrologist is that of a physician who provides a competent and comprehensive range of renal services based on an in depth and lengthy training leading to a sound knowledge and expertise in the field. Many of these tenants are inapplicable in countries where nephrology is emerging along with the country itself. There, the “nephrologists” will not be providing a range of renal services as these are not available due to lack of funds and infrastructure. Instead, they will provide a limited service with little scope for expansion. For that their training requirements, knowledge, and skills may be very different from those of colleagues practicing in the more affluent West. For instance, many developing countries don’t have renal replacement therapies (RRT). Dialysis, when available, may be limited to the management of patients with acute renal failure (ARF). In other countries, chronic hemodialysis may be available in a few centers catering for a small number of privileged patients, often for a limited and short period of time. CAPD is unheard of in the majority of developing nations where the social and economical conditions are not supportive of such a form of RRT. Renal transplantation is not an option in most developing nations.
Diagnosis: an introduction
Rolf Ahlzén, Martyn Evans, Pekka Louhiala, Raimo Puustinen in Medical Humanities Companion, 2018
The rise of modern medicine has been closely associated with the development of more precise and systematic nomenclatures, usually based on pathophysiology. The ICD- 10 now dominates throughout the world. It is gradually expanding, as new scientific knowledge is built into the system and as new conditions ‘appear’ as disease states. Meanwhile, other diagnoses disappear. The system now resembles a huge tree, spreading out into ever narrower branches. Some small branches disappear, while new ones appear. Out there, in the periphery, highly specialised clinicians make use of diagnoses that most often are unknown to the vast majority of other physicians. In renal medicine, for example, chronic inflammatory disease of the glomeruli of the kidney is now represented by eight different diagnoses, based on differences in pathology. No physician except the nephrologists needs to know very much about this, and GPs will usually consider only the larger diagnostic branch ‘chronic glomerulonephritis’.
Case 1
Atul B. Mehta, Keith Gomez in Clinical Haematology, 2017
Baseline tests should include paraprotein quantification in serum and urine (Bence Jones protein), skeletal survey, beta-2 microglobulin and C-reactive protein. Other baseline tests should include a coagulation profile, culture of mid-stream urine and assessment of antibodies to hepatitis A, B and C. Serum-free light chains should be estimated as they are elaborated by the tumour cells and are often the principal cause of the renal toxicity. A renal biopsy should be considered, and the nephrologist will wish to undertake a range of tests to exclude other causes of acute renal impairment. A complete cardiac assessment including echocardiography is important, and the presence of amyloid deposition, for example, in heart and kidneys should be considered. Baseline assessment should also include genetic analysis of the cells by fluorescent in situ hybridization (FISH) and/or chromosome analysis. The International Staging System (ISS) for myeloma is given in the table.
Chinese physician perceptions regarding industry support of continuing medical education programs: a cross-sectional survey
Published in Medical Education Online, 2020
Christopher R. Stephenson, Qi Qian, Paul S. Mueller, Cathy D. Schleck, Jayawant N. Mandrekar, Thomas J. Beckman, Christopher M. Wittich
We performed a cross-sectional survey study of all attendees at Nephrology Update West Lake Forum in Hangzhou, China, in 2017 [27]. The Nephrology Update West Lake Forum is an annual 5-day course that is jointly organized by the Mayo Clinic Alix School of Medicine, Second Military Medical University, and China and Zhejiang University. The course provides nephrologists, internists, and other practicing health care providers with clinically relevant updates for kidney disease and related conditions. The course consists of podium presentations and workshops. Course faculty are chosen by the course directors and are experts in their field. The course offers 20 CME credits and is endorsed by the American Society of Nephrology and the International Society of Nephrology. The conference received industry support to offset the costs of food and participant transportation to and from the course. Industry groups also could buy space and set up displays in an exhibit hall. This study was deemed exempt by the Mayo Clinic and Zhejiang University institutional review boards.
The in- and out-of-hospital management of HF patients: results from a nationwide Belgian survey
Published in Acta Cardiologica, 2021
Liesbeth F. Ghys, Pieter Martens, Ward A. Heggermont, Laurence Gabriel, Alex Heyse, Pierre Troisfontaines, Michael Maris
Patients reach the cardiologist by general practitioners referral, direct appointment, or emergency after acute event, with no marked differences, as these three paths were indicated by 78%, 72% and 71% of the cardiologists respectively. The cardiologists’ perception of the role of the general practitioner, geriatrician and nephrologists in HF management is illustrated in Table 3. General practitioners are considered more important in the follow-up of HF patients, to monitor blood parameters and recognise worsening HF. Nephrologists are mostly consulted for treatment advice and for managing dialysis, and geriatricians for managing comorbidities and polypharmacy. Treatment advice by nephrologists and geriatricians was indicated by 75% and 50% of the dedicated HF cardiologists, compared to 61% and 29% of the non-dedicated HF cardiologists. In contrast, managing polypharmacy by geriatricians is perceived more importantly by non-dedicated HF cardiologists (80%) compared to the dedicated HF cardiologists (63%). However, none of the differences were significant.
Dual phenotype: co-occurring Leber congenital amaurosis and familial exudative vitreoretinopathy: a case report
Published in Ophthalmic Genetics, 2023
Virginia Miraldi Utz, Jared J. Ebert, Diana S. Brightman, Brittany N. Simpson, Stefanie Benoit, Robert A. Sisk
IQCB1 encodes the protein nephrocystin-5, which is expressed in the connecting cilia of photoreceptor cells and the primary cilia of renal epithelial cells (https://doi.org/10.1038/ng1520). Thus, biallelic pathogenic variants in IQCB1 lead to a ciliopathy with both ocular and renal manifestations known as Senior Loken Syndrome 5 (SLS 5). The ocular findings include early-onset, severe retinal degeneration, and vision loss. The renal component is called juvenile nephronophthisis, and is a progressive cystic kidney disease characterized by polyuria, anemia, and decreasing kidney function that typically results in end-stage kidney disease in early adolescence (https://doi.org/10.1111/nep.13393). Hence, early nephrology involvement is imperative, and routine screening must be performed to detect early stages of renal disease.
Related Knowledge Centers
- Renal Replacement Therapy
- Systemic Disease
- Kidney Transplantation
- Internal Medicine
- Kidney
- Pediatrics
- Assessment of Kidney Function
- Renal Physiology
- Kidney Disease
- Kidney Dialysis