Nefroloji

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