Nefroloji

Each year in the United States, approximately 120,000 people with kidney failure choose to start dialysis therapy — an arduous, life-sustaining treatment — and more than half a million patients already receiving dialysis continue their treatment. More than 80% of

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The coronavirus disease 2019 (Covid-19) pandemic has caused catastrophic disease worldwide, although children have been relatively spared. Severe lung involvement with acute respiratory failure is the most common complication of Covid-19 in adults, but many have complications in multiple organs,…

On presentation to the emergency department, patients with fever, tachypnea, rales on lung examination, and acid–base disturbances are often given a suspected diagnosis of viral infection, yet persons with salicylate toxicity may present with similar symptoms. This article highlights the

The prevalence and severity of chronic kidney disease (CKD) has been increasing for decades. Because of its tremendous financial and health burden, both to persons and to health systems, mitigation of the progression of CKD is of critical importance. Two

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), can infect host cells by means of interaction with membrane-bound angiotensin-converting enzyme 2 (ACE2) on respiratory epithelium. ACE2 is part of the…

To the Editor: Chronic kidney disease of unknown origin is a leading cause of death in adults living in dry, lowland farming regions of Sri Lanka, Nicaragua, El Salvador, and India. The Central Valley of California has a high annual

Presentation of Case. Dr. Meridale V. Baggett: A 68-year-old man was admitted to this hospital with fever, shortness of breath, and acute kidney injury during the pandemic of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome

Presentation of Case. Dr. Joseph A. Rosenthal (Medicine): A 79-year-old man was admitted to this hospital because of hyponatremia and involuntary movements of the arm and face. The patient had been in his usual state of health and walking 3

Presentation of Case. Dr. Meridale V. Baggett: A 68-year-old man was admitted to this hospital with fever, shortness of breath, and acute kidney injury during the pandemic of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome

To the Editor: Some researchers have hypothesized that drugs that interfere with the renin–angiotensin–aldosterone system (RAAS), including angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), may increase susceptibility to coronaviruses. This hypothesis is based…

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Studies in animals have shown that angiotensin-converting enzyme 2 (ACE2), a membrane-bound aminopeptidase that is abundantly expressed in the lungs, the heart, and other tissues, is used by coronaviruses as a functional receptor for their entrance into the cells. Angiotensin-receptor

Caustic substances injure tissue by means of a chemical reaction on direct physical contact. Often thought of as acids or bases, caustics broadly include desiccants, vesicants, and protoplasmic poisons. The term “corrosive” is often used interchangeably with “caustic,” but corrosion

To the Editor: Kidney-transplant recipients appear to be at particularly high risk for critical Covid-19 illness due to chronic immunosuppression and coexisting conditions. At Montefiore Medical Center, we identified 36 consecutive adult kidney-transplant recipients who tested positive for Covid-19…

Cardiovascular disease is the leading cause of death in patients with chronic kidney disease. The presence of kidney disease has been associated with an increased risk of procedural complications (including renal injury) from coronary angiography and revascularization, and it is

The preferred contemporary approach to the management of stable ischemic heart disease, also referred to as chronic coronary syndrome, is not well defined. Two strategies are commonly used. The conservative strategy uses guideline-based medical therapy, including antianginal drugs as well

Presentation of Case. Dr. Sarimer Sanchez (Medicine): A 37-year-old man was admitted to this hospital because of a facial droop, dysarthria, and kidney failure. The patient had been well until 1 week before admission, when weakness of the right arm

The preferred contemporary approach to the management of stable ischemic heart disease, also referred to as chronic coronary syndrome, is not well defined. Two strategies are commonly used. The conservative strategy uses guideline-based medical therapy, including antianginal drugs as well

Presentation of Case. Dr. Sarimer Sanchez (Medicine): A 37-year-old man was admitted to this hospital because of a facial droop, dysarthria, and kidney failure. The patient had been well until 1 week before admission, when weakness of the right arm

The preferred contemporary approach to the management of stable ischemic heart disease, also referred to as chronic coronary syndrome, is not well defined. Two strategies are commonly used. The conservative strategy uses guideline-based medical therapy, including antianginal drugs as well

Cardiovascular disease is the leading cause of death in patients with chronic kidney disease. The presence of kidney disease has been associated with an increased risk of procedural complications (including renal injury) from coronary angiography and revascularization, and it is

The preferred contemporary approach to the management of stable ischemic heart disease, also referred to as chronic coronary syndrome, is not well defined. Two strategies are commonly used. The conservative strategy uses guideline-based medical therapy, including antianginal drugs as well

Cardiovascular disease is the leading cause of death in patients with chronic kidney disease. The presence of kidney disease has been associated with an increased risk of procedural complications (including renal injury) from coronary angiography and revascularization, and it is

The preferred contemporary approach to the management of stable ischemic heart disease, also referred to as chronic coronary syndrome, is not well defined. Two strategies are commonly used. The conservative strategy uses guideline-based medical therapy, including antianginal drugs as well

Presentation of Case. Dr. Christian C. Mewaldt (Medicine): An 83-year-old man was transferred to this hospital because of pancytopenia and acute renal failure. Five days before this presentation, the patient was found conscious on his bedroom floor; he had been

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The report by Jafar et al. in this issue of the Journal suggests that a low-cost intervention, if scaled up, “might translate into substantial reductions in premature deaths and disability.” This potential benefit arises from the reduction in systolic blood

Uncontrolled high blood pressure is the leading attributable risk factor for death globally. Treatment of hypertension reduces risk, but less than one third of persons with hypertension have controlled blood pressure. Asians have enhanced susceptibility to vascular disease. Uncontrolled blood…

The report by Jafar et al. in this issue of the Journal suggests that a low-cost intervention, if scaled up, “might translate into substantial reductions in premature deaths and disability.” This potential benefit arises from the reduction in systolic blood

Uncontrolled high blood pressure is the leading attributable risk factor for death globally. Treatment of hypertension reduces risk, but less than one third of persons with hypertension have controlled blood pressure. Asians have enhanced susceptibility to vascular disease. Uncontrolled blood…

The report by Jafar et al. in this issue of the Journal suggests that a low-cost intervention, if scaled up, “might translate into substantial reductions in premature deaths and disability.” This potential benefit arises from the reduction in systolic blood

Uncontrolled high blood pressure is the leading attributable risk factor for death globally. Treatment of hypertension reduces risk, but less than one third of persons with hypertension have controlled blood pressure. Asians have enhanced susceptibility to vascular disease. Uncontrolled blood…

Plasma exchange has been a mainstay of induction therapy for patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis who have rapidly progressive glomerulonephritis or diffuse alveolar hemorrhage. Clinical data, in vitro data, and data from studies in animals have shown that…

End-stage kidney disease (ESKD) and premature death remain common among patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis who present with reduced kidney function or pulmonary hemorrhage. Poor outcomes are attributed to a delay in diagnosis and to the use of

Plasma exchange has been a mainstay of induction therapy for patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis who have rapidly progressive glomerulonephritis or diffuse alveolar hemorrhage. Clinical data, in vitro data, and data from studies in animals have shown that…

To the Editor: In 2016, following the Supreme Court of Canada’s Carter Decision, medical assistance in dying (MAID) became possible with individual court orders. However, owing to the lack of a centrally coordinated Canadian response to the requests of some

The incidence of acute kidney injury is increasing globally. Acute kidney injury occurs in 2 to 5% of hospitalized adults and has a major effect on morbidity and health care utilization. The largest burden of acute kidney injury occurs in

Risk prediction is an inherently challenging, routine clinical necessity — used during initial emergency department presentation, in the intensive care unit (ICU), and in the evaluation of patients for elective procedures such as coronary angiography or surgery. Routine laboratory determinations…

Chronic kidney disease–associated pruritus, also known as uremic pruritus, is a common, distressing, and underrecognized condition that affects more than 60% of patients undergoing hemodialysis, with 20 to 40% of patients reporting moderate-to-severe pruritus. Intense and generalized systemic…

Presentation of Case. Dr. Blake A. Niccum (Medicine): A 64-year-old man was admitted to this hospital in the spring because of acute renal failure. The patient had been generally well until 4.5 months before this admission, when fevers, malaise, mild

Chronic kidney disease–associated pruritus, also known as uremic pruritus, is a common, distressing, and underrecognized condition that affects more than 60% of patients undergoing hemodialysis, with 20 to 40% of patients reporting moderate-to-severe pruritus. Intense and generalized systemic…

Presentation of Case. Dr. Blake A. Niccum (Medicine): A 64-year-old man was admitted to this hospital in the spring because of acute renal failure. The patient had been generally well until 4.5 months before this admission, when fevers, malaise, mild

Chronic kidney disease–associated pruritus, also known as uremic pruritus, is a common, distressing, and underrecognized condition that affects more than 60% of patients undergoing hemodialysis, with 20 to 40% of patients reporting moderate-to-severe pruritus. Intense and generalized systemic…

To the Editor: The HIV Organ Policy Equity (HOPE) Act allows persons living with human immunodeficiency virus (HIV) infection to accept HIV-positive donor organs. An analysis of viral quasispecies from donor and recipient provides an opportunity to determine whether the

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows.

Chronic kidney disease–associated pruritus, also known as uremic pruritus, is a common, distressing, and underrecognized condition that affects more than 60% of patients undergoing hemodialysis, with 20 to 40% of patients reporting moderate-to-severe pruritus. Intense and generalized systemic…

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage.

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To the Editor: Primary membranous nephropathy, one of the most common causes of nephrotic syndrome in adults, results from the deposition of IgG and complement components in the subepithelial layer of the glomerular basement membrane. In 70 to 80% of

To the Editor: The longer-term clinical outcomes of renal transplantation in human immunodeficiency virus (HIV)–positive patients who have received organs from HIV-positive donors, as well as the potential risks associated with donor-derived HIV superinfection among such patients, are unknown. We…

Chronic kidney disease is a global public health challenge that affects approximately 10% of the population worldwide, including 120 million people in China. Anemia (defined as a hemoglobin level of In China, this situation is reflected by low hemoglobin levels

Until 1989, when recombinant erythropoietin therapy was first approved, anemia of chronic kidney disease could be treated only symptomatically with blood transfusions. Erythropoiesis-stimulating agents were able to increase patients’ hemoglobin levels to between 9 and 11 g per deciliter, resulting…

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Cardiovascular disease is the primary cause of death in patients with type 2 diabetes, and the ruling out of an excess cardiovascular risk is a regulatory requirement for new glucose-lowering therapies. Glucagon-like peptide-1 (GLP-1) receptor agonists are well-established glucose-lowering…

The world’s climate crisis has spared no one. Science tells us that the harms of climate change will worsen with time if we fail to take substantial actions now to reduce carbon pollution. In the United States, the growing burden

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Early in the morning, my intern told the patient that his kidneys had quit working, that he was in danger from electrolyte derangements, and that dialysis could save his life. In the 24 hours since his admission to the hospital,

The world’s climate crisis has spared no one. Science tells us that the harms of climate change will worsen with time if we fail to take substantial actions now to reduce carbon pollution. In the United States, the growing burden

Presentation of Case. Dr. Doll L. Golden (Medicine): A 65-year-old woman was admitted to this hospital because of falls, weakness, dark urine, and difficulty swallowing. Approximately 35 years before the current admission, the patient underwent staged male-to-female sex reassignment surgery

Thresholds for hypertension and prevailing concepts about hypertension have shifted over time. Constructs about the consequences of isolated diastolic, isolated systolic, and combined systolic and diastolic hypertension evolved in the 1960s, with a prevailing notion that only diastolic hypertension…

Presentation of Case. Dr. Doll L. Golden (Medicine): A 65-year-old woman was admitted to this hospital because of falls, weakness, dark urine, and difficulty swallowing. Approximately 35 years before the current admission, the patient underwent staged male-to-female sex reassignment surgery

Membranous nephropathy is the leading cause of nephrotic syndrome in white adults. Spontaneous remission occurs in approximately 30% of affected patients, and among patients who continue to have nephrotic syndrome, end-stage renal disease develops in 40 to 50% over a

Membranous nephropathy, the leading cause of nephrotic syndrome in adults (approximate incidence among white adults without diabetes, 8 to 10 cases per million population per year), is the result of IgG deposition in the subepithelial space of glomerular capillaries. Strategies

Membranous nephropathy is the leading cause of nephrotic syndrome in white adults. Spontaneous remission occurs in approximately 30% of affected patients, and among patients who continue to have nephrotic syndrome, end-stage renal disease develops in 40 to 50% over a

Membranous nephropathy, the leading cause of nephrotic syndrome in adults (approximate incidence among white adults without diabetes, 8 to 10 cases per million population per year), is the result of IgG deposition in the subepithelial space of glomerular capillaries. Strategies

Increased blood pressure is the largest single contributor to the global burden of disease, leading to 10.4 million deaths in 2017. Extensive data from randomized trials have shown that lowering blood pressure reduces cardiovascular morbidity and mortality. Results from such

The treatment of metastatic renal-cell carcinoma has been revolutionized twice in the past 12 years by data showing that vascular endothelial growth factor (VEGF) inhibition can induce tumor shrinkage and increase progression-free survival and that immune checkpoint inhibitors can induce

Antimicrobial resistance continues to erode our therapeutic armamentarium for treating patients with bacterial infections. Clinicians are now encountering infections that are susceptible to few or even (although rarely) none of the available drugs. One of the multiple components of a

Urinary tract infections (UTIs) are common bacterial infections that are associated with substantial morbidity, mortality, and economic burden. Complicated UTIs are UTIs in patients who have underlying conditions, such as anatomical abnormalities, or risk factors, such as indwelling urinary…

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A 21-year-old man was found unresponsive in a park, with a 1-gallon container of green liquid, approximately half of it gone, nearby. The label was not legible, but the liquid was presumed to be antifreeze. The man was brought to

Patients undergoing maintenance hemodialysis usually have a negative iron balance owing to reduced absorption and increased blood loss. The intravenous administration of iron has become standard care in the management of anemia, and large doses are increasingly used to reduce

Targeted capture and sequencing of the protein-coding regions of the genome through exome sequencing is increasingly applied as a first-line diagnostic tool in clinical medicine, particularly for the diagnosis of metabolic and neurodevelopmental disorders in children, as well as for

To the Editor: Risk variants in the APOL1 gene on chromosome 22, which were first discovered in African Americans, confer a substantially increased risk of kidney disease, early-onset hypertension, and cardiovascular disease, although disease risk is modified by other genetic

Presentation of Case. Dr. Keyan Salari (Urology): A 29-year-old man was seen at this hospital because of an incidentally discovered renal mass. The patient had been well until 6 weeks before this evaluation, when he identified a painless lump above

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows.

End-stage organ diseases are responsible for millions of deaths worldwide each year. Organ transplantation has become the treatment of choice, but despite the 120,000 new organ transplantations performed each year, only 1 million persons worldwide have functioning solid-organ transplants because

To the Editor: Borna disease virus 1 (BoDV-1; species Mammalian 1 orthobornavirus) causes progressive meningoencephalitis, mainly in horses and sheep. Evidence of BoDV-1 infection in humans is limited. However, after the identification of a bornavirus transmitted by exotic pet squirrels

Since 1972, when the U.S. government began covering the costs of dialysis for nearly all Americans with end-stage renal disease (ESRD), dialysis has become big business. In 2015, the Centers for Medicare and Medicaid Services (CMS) spent roughly $34 billion

Acute kidney injury is a frequent complication in patients hospitalized in the intensive care unit (ICU) for septic shock and is associated with high mortality. Acute kidney injury associated with sepsis is characterized by a distinct pathophysiology, and patients with

A 39-year-old man with end-stage renal disease presented to the emergency department with anorexia, nausea, vomiting, and oliguria. Five months earlier, he had stopped attending his regular hemodialysis sessions; he reported that he had thought that the sessions were not