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Organizational structures of dialysis access care and the role of interventional nephrology: a Germany-wide survey.

BACKGROUND: Ongoing changes in healthcare are expected to significantly reshape the hospital landscape in the coming years. Within this context and in order to respond appropriately, an up-to-date assessment of the structural and process quality of dialysis access care is essential. METHODS: Between April and July 2024, 160 German inpatient nephrology departments were invited to participate in an anonymous online survey. Data were analysed descriptively. RESULTS: A total of 64 hospitals responded (response rate: 40%). Of these, 23% (n = 15) were university hospitals, 45% (n = 29) were tertiary…

Finding the sweet spot in green nephrology: the intersection of environmental sustainability and excellence in patient care.

Sustainability in kidney care is often perceived as requiring trade-offs in clinical quality, yet green nephrology can strengthen clinical excellence by identifying "sweet spots" where improved outcomes and reduced environmental impact align. Organized along the chronic kidney disease (CKD) trajectory, this review highlights opportunities for responsible practice at each stage. Dialysis, the most resource-intensive component of kidney care, finds a sweet spot in reducing redundancy, personalizing treatment, optimizing vascular access, and empowering patients. Approaches such as incremental dia…

Current status and future directions for the use of artificial intelligence in pediatric critical care nephrology.

Artificial intelligence (AI) has the potential to significantly improve the practice of medicine. However, its application in pediatric critical care nephrology remains underdeveloped. This scoping review investigates the current state of AI/machine learning (ML) algorithms developed and implemented in the field of pediatric critical care nephrology over more than two decades (2000-2024). We identified 24 articles related to commonly encountered pathologies including acute kidney injury (AKI), electrolyte and acid-base imbalances, fluid management, and dialysis. Twenty (80%) of these articles …

The evolution of nephrology practice in Egypt: legacy, current challenges, and future directions-a narrative review.

Egypt, home to over 114 million people, hosts a diverse and expanding nephrology landscape, anchored by leading academic institutions and tertiary care centers that provide services across the full spectrum of kidney disease-from acute kidney injury (AKI) and chronic kidney disease (CKD) to dialysis and transplantation. Some centers have earned international recognition for their scientific contributions and attract referrals from across the region. Notwithstanding the range of services offered, the Egyptian healthcare system-which includes insurance-based, commercial, and governmental models-…

Effectiveness and safety of finerenone in the treatment of IgA Nephrology patients: a retrospective, real-world study.

PURPOSE: The proteinuria is closely related to the prognosis of IgA nephropathy (IgAN) patients. Finerenone has been demonstrated to reduce proteinuria in diabetic kidney disease (DKD). However, the role of finerenone in IgAN has not been reported. This study is to analyze the efficacy and safety of finerenone in IgAN. METHODS: This retrospective study analyzed IgAN patients' data post-finerenone treatment, with groups defined by treatment plans at baseline. It observed changes in the urinary albumin-to-creatinine ratio (UACR), the estimated glomerular filtration rate (eGFR), and serum potass

Acute interstitial nephritis in adults: A retrospective case series from a nephrology center in Tunisia.

Introduction-Aim: Acute interstitial nephritis (AIN) shows variability in incidence and etiology based on geography.  The study aimed to understand the characteristics and root causes of AIN, its diagnosis methods, treatment strategies, and results within a Tunisian population. Method: We retrospectively gathered data on biopsy-proven AIN from a Nephrology center over 16 years.  Results: We gathered 36 confirmed cases of biopsy-proven AIN. The average age of the patients was 50.58 years. The predominant clinical signs were fatigue (58%) and fever (22%). The mean level of creatinine was 691.58 …

Kidney care in patients with cancer: perspectives from the onconephrology committee of the Brazilian Society of Nephrology.

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… Since its creation, ASON has established a partnership with the International Society of Nephrology, leading to active collaborations with nephrology societies across the globe, including Asia, Africa, and South America. … In parallel, symposiums, premeetings, and scientific and poster sections are now routine at the American Society of Nephrology meetings, the World Congress of Nephrology, and other top nephrology congresses worldwide. …

Snow White's tale in nephrology: the emerging threat of skin-whitening creams on kidney health.

The timeless tale of Snow White, with its emphasis on fair skin as a beauty ideal, mirrors a contemporary issue in nephrology: the harmful impact of skin-whitening creams on kidney health. Fairness creams have deeply embedded themselves in global society, driven by a pervasive obsession with lighter skin tones as a symbol of beauty. This widespread use reflects deeply rooted cultural beliefs and social norms, despite the significant health risks associated with these products. Despite regulatory bans, these creams often contain hazardous substances such as hydroquinone, mercury, and arsenic, p…

Utility of fractional excretion of magnesium in diagnosing renal magnesium wasting in pediatric nephrology practice.

BACKGROUND: Fractional excretion of magnesium (FEMg) is commonly used to diagnose of renal magnesium (Mg) wasting, but it can be affected by serum Mg (SMg) and serum creatinine concentration (SCr). We investigated the sensitivity and specificity of FEMg to diagnose Mg wasting in subgroups with different SMg and eGFR (estimated glomerular filtration rate) in pediatric nephrology practice. METHODS: One hundred and nineteen patients (59 males and 60 females, median 15 years) seen in our pediatric clinic were investigated for FEMg, SMg, eGFR, and urine Mg-to-creatinine ratio (Mg/Cr). Normal eGFR …

Antibiotic Antibiogram in Patients With Complicated Urinary Tract Infections in Nephrology Unit of South Waziristan.

Objectives To evaluate the antibiotic antibiogram in patients with complicated urinary tract infections (cUTIs) presenting to a Nephrology unit of South Waziristan. Methods A cross-sectional study was conducted at the Department of Nephrology, Sholam, South Waziristan. The study included all patients who presented with cUTIs and the symptoms included urinary urgency, hematuria, dysuria, suprapubic discomfort, and increased frequency. Those patients with clinical manifestations but are on antibiotics within the past five days were excluded. Results A total of 158 patients were included in the s…

Effect of Coronavirus Disease 2019 on Transplantation and Nephrology in India: A Nationwide Report From India.

BACKGROUND: The effect of coronavirus disease 2019 (COVID-19) on a developing nation is sparsely reported and, more importantly, the discrepancies in public and private sectors are underexplored. METHODS: We retrospectively investigated the data on the effect of COVID-19 on renal transplantation between 2019 and 2020 in a nationwide analysis from 8 public and 10 private sector hospitals of India. RESULTS: On comparing the yearly data, the number of living-related transplants and deceased donor transplants declined by 48% (2610 vs 1370) and 49% (194 vs 99), respectively. The outpatient number

Mass Disasters and Burnout in Nephrology Personnel: From Earthquakes and Hurricanes to COVID-19 Pandemic.

Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to wo…

Clinical Response and Pattern of B cell Suppression with Single Low Dose Rituximab in Nephrology.

BACKGROUND: There is no consensus regarding dose and frequency of rituximab in nephrology with extrapolation of doses used in treating lymphoproliferative disorders. There are no guidelines on targeting initial and subsequent doses on the basis of CD19+ B cells. METHODS: Initially, 100 mg rituximab was given to 42 adults with steroid-dependent nephrotic syndrome (SDNS) and frequently relapsing nephrotic syndrome (FRNS), idiopathic membranous nephropathy (MN), and high-immunologic-risk kidney transplantation. Absolute and percentage levels of CD19 B cells and clinical status were assessed at b…

Renal Survival in Children with Glomerulonephritis with Crescents: A Pediatric Nephrology Research Consortium Cohort Study.

There is no evidence-based definition for diagnosing crescentic glomerulonephritis. The prognostic implications of crescentic lesions on kidney biopsy have not been quantified. Our objective was to determine risk factors for end-stage kidney disease (ESKD) in patients with glomerulonephritis and crescents on kidney biopsy. A query of the Pediatric Nephrology Research Consortium's Pediatric Glomerulonephritis with Crescents registry identified 305 patients from 15 centers. A retrospective cohort study was performed with ESKD as the primary outcome. Median age at biopsy was 11 years (range 1-21)…

Analysis and management of drug related problems on a nephrology ward from a pharmacist's point of view.

The main goal of the study was to determine the incidence and the character of drug related problems (DRPs) identified in chronic kidney disease patients by the clinical pharmacist at the nephrology department. As secondary objective, the aim was to identify the frequency and character of DRPs of selected high risk drugs in medication reviews. The clinical pharmacist reviewed patients' medication records and made drug therapy-related recommendations to physicians. The clinical pharmacists' interventions were categorized using an adaptation of the Pharmaceutical Care Network Europe. During the …

Factors predicting vancomycin therapy outcomes in hemodialysis outpatients and the role of the nephrology stewardship pharmacist.

BACKGROUND: Vancomycin is the default antibiotic to treat methicillin-resistant Staphylococcus aureus (MRSA) in hemodialysis (HD) units. Current guidelines recommend a vancomycin trough range of 15 to 20 mg/L for serious infections. Data regarding the clinical success of these recommendations are scarce in HD patients. PURPOSE: The purpose of this studies is to evaluate the treatment outcomes of vancomycin in HD patients. METHODS: A retrospective chart review of HD outpatients who received parenteral vancomycin for suspected or documented MRSA infections in a community hospital in southweste

Evaluation and control of microbial and chemical contamination in dialysis water plants of Italian nephrology wards.

BACKGROUND: Patients receiving haemodialysis are exposed to a large volume of dialysis fluid. The Italian Society of Nephrology (ISN) has published guidelines and microbial quality standards on dialysis water (DW) and solutions to ensure patient safety. AIM: To identify microbial and chemical hazards, and evaluate the quality of disinfection treatment in DW plants. METHODS: In 2015 and 2016, water networks and DW plants (closed loop and online monitors) of nine dialysis wards of Italian hospitals, hosting 162 dialysis beds overall, were sampled on a monthly basis to determine the parameters …

Haematological malignancies and acute kidney injury requiring nephrology consultation: challenging the worst of the worst.

BackgroundAcute kidney injury (AKI) often complicates the course of haematological malignancies (HMs) and confers a worse prognosis. The majority of these patients are managed by the attending physician, yet, a small group, mostly coincident with the worst presentation and outcomes, requires nephrology consultation, challenging the clinician with ethical issues regarding the decision to initiate or forgo renal support therapy. The purpose of this work is to identify the prognostic determinants for in-hospital mortality in this population.MethodsA retrospective, observational chart review was u…

We still go for the jugular: implications of the 3SITES central venous catheter study for nephrology.

The 3SITES study randomly assigned a nontunneled central venous catheter site in over 3000 adults treated in intensive care units. The subclavian site was associated with a lower rate of short-term complications, including catheter-related bloodstream infection and deep venous thrombosis, compared to the femoral or internal jugular site. Nephrologists should be aware of this study and should continue to advocate for alternatives to subclavian vein catheter placement in patients with chronic kidney disease who are expected to require arteriovenous access for dialysis in the future.

[Idiopathic Nephrotic Syndrome: recommendations of the Nephrology Branch of the Chilean Society of Pediatrics. Part two].

Idiopathic nephrotic syndrome is the most common glomerular disease in childhood, affecting 1 to 3 per 100,000 children under the age of 16. … nal survival than the lack of response. This paper is the result of the collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with aims at helping pediatricians and pediatric nephrologists to treat pediatric idiopathic nephrotic syndrome. In this second part, handling of steroid-resistant nephrotic syndrome as well as nonspecific …