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PubMedDate not supplied

Nephrology in the Lancisi Medical Dictionary (1672-1720).

Giovanni Maria Lancisi (1654-1720) shows a particular interest in urological and nephrological diseases, especially evident in a course of lectures held at Studium Urbis in 1696-97, which reflected his vast knowledge and familiarity with various important texts devoted to urology and nephrology. This interest is further documented in commentaries on articles on nephrological diseases in his Repertorium medicum (a sort of medical dictionary written between 1672 and his death). Lancisi's quoting medical authorities clarifies the clinical answers he gave in some of his unpublished Consulti concerning nephrological pathologies.

Dictionaries, Medical as Topic↗
PubMed1990

Certification in nephrology nursing: an interview with NNCB president Janel Parker. Interview by Patricia S Jordan.

Certification in nephrology nursing became a reality in 1987 with the formation of the Nephrology Nursing Certification Board (NNCB), and the development and administration of the nephrology nursing certification examination. Three years later, NNCB President Janel Parker discusses the evolution of the NNCB examination, the significance and impact of the examination, and the future of certification in nephrology nursing.

Certification↗
PubMed1997

The institution of care pathways in nephrology patient care: a response to the changing health care climate.

The development of managed health care in the United States has provided an impetus for new strategies that promote efficiency, streamline healthcare delivery, and maintain quality care. The increasing number of end-stage renal disease patients, their complexity of care, and a looming manpower shortage in nephrology strain the present system trying to meet these demands. One mode of healthcare delivery that may address specific needs in the nephrology population is case management. This approach to medical care uses a care pathway that serves as a multidisciplinary blueprint for patient care. Such pathways eliminate duplicated services and maximize efficiency by keeping the healthcare team focused. In response to market forces in our community, we implemented care pathways for percutaneous renal biopsy and vascular access surgery. Costs per procedure and hospital length of stay were reduced. Patient outcomes and procedure success rates were unchanged from pre-pathway years. Moreover, patients preferred the care pathway care for their problems. Case management and care pathways are tools that are effective in their scope for helping deliver better care for nephrology patients. While they should not be considered a panacea for the problems facing renal care providers, these tools should be considered as part of nephrology healthcare delivery in the future.

Biopsy↗
PubMedDate not supplied

Interventional nephrology in Puerto Rico.

Vascular access is emerging as a critical issue for hemodialysis patients in Puerto Rico. In more than 50% of the hemodialysis patients, tunneled hemodialysis catheters are the sole access for providing dialysis therapy. Most disturbing is the fact that a significant number of these catheters are nontunneled temporary catheters, sometimes placed in the subclavian vein. These facts have contributed significantly to the morbidity and mortality seen in chronic dialysis patients. In addition, many cases of early or late dysfunction of arteriovenous access are not detected and treated in a timely manner due to the lack of a comprehensive vascular access program for end-stage renal disease (ESRD) patients. In fact, monitoring programs to identify and detect vascular access dysfunction are virtually nonexistent in many chronic dialysis units. Even when diagnosed, it is not treated in a timely fashion. Recently literature has shown that procedure-related delays in the treatment of patients with renal disease can be minimized and nephrology care more efficiently delivered by a nephrologist trained in nephrology-related procedures. In an effort to optimize the care of our ESRD patients, we took the initiative to develop an interventional nephrology program that effectively deals with vascular access-related procedures in a timely manner. This approach has minimized delays, decreased hospitalizations and the use of temporary catheters, and improved the medical care of our chronic dialysis patients. So far we have performed more than 400 procedures in the 6 months since the initiation of the program. In this article we describe our initial experience with interventional nephrology in Puerto Rico.

Angioplasty, Balloon↗
PubMed2000

Occurrence of hyperhomocysteinaemia in cardiovascular, haematology and nephrology patients: contribution of folate deficiency.

We investigated the contribution of plasma folate deficiency to hyperhomocysteinaemia in selected patient groups. Based on our observations, we have determined a lower folate reference interval cut-off using homocysteine as a metabolic marker of folate deficiency. Four hundred and twenty-five consecutive plasma specimens from cardiology (n = 120), haematology (n = 190) and nephrology (n = 115) patients were analysed for homocysteine and plasma folate concentrations. Healthy volunteers were used as controls (n = 117). We observed elevated homocysteine values above our upper reference limit of 13 micromol/L in 20.1%, 28.4% and 74.8% of the cardiology, haematology and nephrology patients, respectively. All but 1.9% of the patients had plasma folate values greater than the lower reference interval limit (3.4 nmol/L) for our folate assay. The percentage of patients from cardiology and haematology clinics who were hyperhomocysteinaemic and had folate values > 15 nmol/L was 5.0% and 4.2%, respectively. In contrast, 58% of our nephrology patients with folate values > 15 nmol/L were hyperhomocysteinaemic. In all three groups, an inverse relationship was found between folate and homocysteine. The folate/homocysteine ratios in the patient groups were approximately one-third of the values observed in our control group. Folate deficiency appears to be the primary cause of hyperhomocysteinaemia in our cardiology and thrombosis patients. However, severe folate deficiency appears to be uncommon. The majority of our nephrology patients are hyperhomocysteinaemic without an apparent folate deficiency. We conclude that raising the lower reference interval cut-off for folate to 15 nmol/L would help to identify individuals at risk for hyperhomocysteinaemia in our non-uraemic patient population. Increasing folate supplementation to maintain a plasma concentration above 15 nmol/L in cardiac, thrombosis and renal patients would greatly reduce the occurrence of hyperhomocysteinaemia in these patients.

Cardiovascular Diseases↗
PubMed1991

Paediatric nephrology on the threshold of European integration.

The European Society for Paediatric Nephrology (ESPN) was founded 25 years ago. The progress of paediatric nephrology in Europe since then has been considerable, but we now face a number of problems. The care of the child with kidney disease is often expensive and more needs to be done to examine the cost effectiveness of the management of the child with kidney disease. International co-operation can also foster clinical research to determine the effectiveness of treatment through the institution of controlled trials and outcome studies. Particular problems are posed by the need to integrate the countries of Eastern Europe that have changed from command to market economies over the last year. In many instances there is no shortage of doctors, nurses and hospital beds but there is a need to change administrative and academic structures and to introduce appropriate technology. It is suggested that this may be assisted by twinning units. The integration of Europe requires that the role of the paediatric nephrologist in different countries needs to be examined, and appropriate training to fulfil these responsibilities needs to be agreed. Different countries obviously have different ways of organising and providing services for children with kidney disease. Kidney failure is rare in childhood and there are economic and academic advantages from close collaboration, both with adult nephrology services and with other paediatric specialities. Where it is intended to integrate children's hospitals into large multidisciplinary university hospitals for economic reasons, it is nonetheless necessary to make sure that the requirements of children are properly recognised and the requirements of the European Charter for children in hospital are met.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed2005

The future of pediatric nephrology.

The delineation of renal disease in children dates to the 1880s with descriptions of Henoch's purpura, bladder exstrophy, renal rickets and nephritis. The discipline of pediatric nephrology mainly emerged during the 20th century in response to problems in fluid and electrolyte balance, characterization of the nephrotic syndrome, use of renal biopsy, antibiotic therapy of urinary tract infections, dialysis and transplantation in children, growth problems associated with chronic renal failure, detection and therapy of hypertension, and the creation of both national and international pediatric nephrology societies and a journal now in its 18th year. The development of molecular and cell biology, genetic and genomic techniques and bioinformatics methods underlie many future directions. We should anticipate further elucidation of single gene disorders, of complex trait analysis of disorders, such as diabetic nephropathy and hypertension, the interplay of developmental genes and gene products and interactions within the podocyte. Specific therapies directed against inflammation, vascular damage, cyst development, the ravages of proteinuria and graft rejection (or induction leading to tolerance) will be developed. Stem cell therapies may replace lost renal mass, even of specific nephron sites. Novel therapies will also modulate the cell cycle, tyrosine kinase signaling and apoptosis. In addition, drugs will be specifically tested in children for many renal conditions. Larger and more specialized registries will be developed; epidemiologic studies and exploration of large data sets will lead to clinical guidelines that are evidenced-based. There is a need for more careful measurement of glomerular filtration rate (GFR), proteinuria and cytokines, and a fuller appreciation of the nutritional and hormonal role of the kidney. Finally, the antecedents of adult renal disease and the need to intervene in a proactive fashion will be realized. Despite these impressive advances in care, the greatest challenges will be in providing children with renal disease access to well-trained pediatric nephrologists, especially in Asia (1 billion children), Africa, Central and South America, and in immigrant and refugee populations. Included in this challenge is the capacity to have affordable access to use of contemporary techniques, and effective medications and prevention strategies. The International Pediatric Nephrology Association (IPNA), its journal, and pediatric advocates will need to use their energies to take on these challenges.

Child↗
PubMed1998

A review of a psychiatry-nephrology liaison service.

A review was carried out of the work of a liaison psychiatry service to a paediatric nephrology team over a 4 year period. Elements of the service included a monthly meeting between psychiatry staff and all disciplines in the nephrology team, direct referrals for assessment and treatment by the psychiatry team, and 'telephone advice'. Direct assessments of 38 cases were made; 20 had 2 or more follow-up appointments. Three methods of audit are presented: a review of psychiatric diagnosis with comparison of patients with chronic renal failure and those with other disorders associated with the renal tract, outcome and interventions, costing of intervention in two cases, and a 'consumer satisfaction' questionnaire to nephrology team members. Those responding to the questionnaire (13/21) valued the liaison service. Their comments particularly endorsed the monthly liaison meeting which provided an opportunity to review critically the management of long term and challenging cases.

Adolescent↗
PubMed2005

[Patterns of nephrology referral and predialysis management of patients with chronic kidney disease].

INTRODUCTION: Numerous studies showed that late referral (LR) to a nephrologist of patients with chronic kidney disease stated by a simple quantitative criterium (initiation of renal replacement therapy (RRT) within 3 or 4 months of referral to a nephrologist, independantly from the quality of care) is associated with worse survival rate, limited to the first 3 months following the initiation of RRT. We wanted to test a criterium of LR definition supposing a more important "dose of nephrological care", to try to understand the reasons of this early death. METHODS: One hundred and thirty-eight patients receiving their first RRT in 1999 and 2000 in Valenciennes (France) were enrolled in this study. Two LR definitions were used: a qualitative criterium C1 (whether the patient was under an uninterrumpted nephrological pre-dialysis care - independantly from the date of the nephrological referral - or not) and a more simple quantitative criterium C2 (initiation of RRT within 3 months of referral to a nephrologist). Comorbidity was assessed by Charlson's score. The analysis concerned the respective influence of C1 and C2 on the clinical and biological effects of chronical azotemia, on the circumstances at first RRT (emergency first dialysis, pulmonary edema, type of vascular access), and on survival rates (Kaplan-Meier's analysis). RESULTS: LR rates are 23% according to C1 and 20% according to C2. Comorbidity is similar in the different groups. Whatever the definition criterium, LR is associated to a lower hemoglobin and albumin, a more severe acidosis, a longer duration of first hospitalization, and higher rate of emergency first dialysis and use of central temporary catheter. The survival rates at 2 years following the first RRT of lately referred patients are 53% according to C1 (vs 86% for early referred patients, P<0,001) and 56% according to C2 (vs 84%, P<0,05). For both, early death (within the first 3 months) explained the observed differences of survival rates. CONCLUSION: In this study, early death of lately referred patients seems to be independant from the criterium of definition of LR. Elements of explanation are suggested, and can lead to further prospective studies.

Humans↗
PubMed2003

Impact of nephrology referral on early and midterm outcomes in ESRD: EPidémiologie de l'Insuffisance REnale chronique terminale en Lorraine (EPIREL): results of a 2-year, prospective, community-based study.

BACKGROUND: Most studies looking at how the outcome of end-stage renal disease (ESRD) is affected by the timing and quality of the care received before initiation of renal replacement therapy (RRT) are inconclusive. METHODS: Five hundred and two adult French patients (age, 62.8 +/- 16 years) receiving their first RRT were enrolled in a 2-year, community-based, prospective study. Subjects were assigned to 1 of 5 groups depending on the time between their first serum creatinine reading above 2 mg/dL (177 micromol/L): chronic renal failure (CRF) and nephrology referral (NR) and RRT. Multivariate logistic regression was used to analyze 90-day survival data, and data concerning long-term survival and inclusion on the waiting list for renal transplantation were analyzed using Cox proportional hazards regression. RESULTS: Overall survival rates were 88% at 90 days, 77.2% at 1 year, 65.2% at 2 years, and 54.2% at 3 years. The nephrology referral pattern was associated with age and systolic blood pressure, and independently predicted early death. Compared with group 1 (NR > 12 months), odds ratios (confidence interval 95%) were 2.7 (1.2 to 6.3) for group 2 (NR < or = 12 months or >4 months), 2.8 (1.0 to 8.0) for group 3 (NR < or = 4 months or >1 month), 4.9 (2.2 to 11.0) for group 4 (NR < or = 1 month; CRF > 1 month), and 5.2 (2.2 to 12.3) for group 5 (NR < or = 1 month; CRF < or = 1 month). Independent predictors of death in 90-day survivors were age, cardiac disease with previous episodes of heart failure, vascular disease, low diastolic blood pressure, and group 3 referral pattern. Not being entered on the waiting list for renal transplantation was predicted by age, diabetes, vascular disease, and nonelective first dialysis. CONCLUSION: Late nephrology referral is strongly associated with early death. Emergency first dialysis is an independent risk factor for not being placed on the waiting list for transplantation. Among 90-day survivors, referral pattern has little influence on mortality, which is mainly determined by cardiovascular complications at initiation of RRT.

Age Factors↗
PubMed1997

Nephrology pharmacy practice in the outpatient dialysis setting.

The outpatient dialysis setting provides an ideal opportunity for specialized pharmaceutical care, yet has been underserved by pharmacists. Experience at SJMC outpatient dialysis center has shown that pharmacists specialized in nephrology can contribute to improved dialysis care and sizable monetary savings. The experience of a successful nephrology pharmacy service may assist other nephrology programs to expand the potential benefits of enhanced pharmacist involvement in the care of the ESRD patient.

Ambulatory Care↗
PubMed2005

Seeking evidence of rehabilitation in nephrology nursing.

Individuals with renal failure experience many varied and complex alterations in their health status. As a consequence, rehabilitation is an important aspect of their care. However, until recently, rehabilitation has not been explicit in the published nephrology nursing literature. This paper addresses that deficit through an examination of Australian nephrology nursing competency standards for evidence of rehabilitation. Recent Australian research about rehabilitation nursing practice was used as a guiding definition of rehabilitation. A systematic examination of these documents revealed evidence of rehabilitative practices embedded in the nephrology nursing competency standards' domains of empowerment and clinical problem solving. These findings add support for the belief that rehabilitation is a philosophy that all nurses can apply in their practice.

Australia↗
PubMed2006

Grading evidence and recommendations for clinical practice guidelines in nephrology. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO).

Considerable variation in grading systems used to rate the strength of guideline recommendations and the quality of the supporting evidence in Nephrology highlights the need for a uniform, internationally accepted, rigorous system. In 2004, Kidney Disease: Improving Global Outcomes (KDIGO) commissioned a methods expert group to recommend an approach for grading in future nephrology guidelines. This position statement by KDIGO recommends adopting the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach for the grading of evidence and guidelines on interventions. The GRADE approach appraises systematic reviews of the benefits and harms of an intervention to determine its net health benefit. The system considers the design, quality, and quantity of studies as well as the consistency and directness of findings when grading the quality of evidence. The strength of the recommendation builds on the quality of the evidence and additional considerations including costs. Adaptations of the GRADE approach are presented to address some issues pertinent to the field of nephrology, including (1) the need to extrapolate from studies performed predominantly in patients without kidney disease, and (2) the need to use qualitative summaries of effects when it is not feasible to quantitatively summarize them. Further refinement of the system will be required for grading of evidence on questions other than those related to intervention effects, such as diagnostic accuracy and prognosis.

Global Health↗
PubMed2003

Japan's share of research output in urology and nephrology.

BACKGROUND: Recent studies have documented Japan's share of articles in different biomedical fields. However, Japan's contribution to urology and nephrology is not known. METHODS: Seven journals in this field with the highest impact factors were selected to obtain relevant data. In June 2002, we searched the Medline database to obtain country affiliation details of articles published in the selected journals during 1991-2000. The proportion of articles with a higher grade of evidence (randomized controlled trials or clinical trials, cohort studies and case-control studies) were also generated and compared to the average values for all articles published in these journals. RESULTS: Of the total number of articles (22 232), Japan's share of research output for the selected journals in urology and nephrology was 6% (1335 articles) and it ranked second in the world following the USA (56.5%). The recent increase in the share was statistically significant for Japan, Austria, France, Germany, Spain and Turkey. The proportion of articles with a high grade of evidence was lower for articles originated in Japan than for the total number of articles. CONCLUSION: Japan's contribution to urology and nephrology research is within the range of its contribution to other biomedical fields. However, the number of high quality clinical research conducted in Japan in this field was small.

Japan↗
PubMed1998

Toward global advancement of medicine: the International Society of Nephrology experience.

BACKGROUND: Since its foundation in 1960, the International Society of Nephrology (ISN) has pursued the worldwide advancement of education, science and patient care in nephrology. This goal was achieved by means of the Society's journal and the organization of international congresses and symposia. In order to better reach its colleagues and patients in economically less developed countries, the ISN expanded its activities as of 1980 by a large number of specific programs aimed at these regions. METHODS: The first phase of activities included teaching programs, fellowship and visiting scholar programs, and the provision of travel grants to enhance accessibility to the ISN congresses. A second phase consisted of the creation of a library enhancement program, a commission on acute renal failure and--to improve the organization and efficiency--a central commission on global advancement of nephrology (COMGAN). Currently, a third phase has been entered in which all activities have been intensified: (1) under the guidance of COMGAN, supported by a large number of teaching programs and fact finding missions; (2) by establishing a renal sister program; and (3) by initiating commissions on informatics and on clinical trials. RESULTS: As a result, the ISN has reached most parts of the world, previously deprived of contact with renal science and renal patient care. The fellowship program now counts 160 fellows, who spend one or two years in training. The library enhancement program reaches 218 institutions worldwide. ISN membership has soared over the past two years with over 2,500 new members, mostly in the developing countries. They receive Kidney International and other relevant forms of information. Thus far, 135 pairs of renal units in developing and developed countries have been linked for support on a more continuous basis. ISN-sponsored congresses, symposia, and courses are being held in increasing numbers in the developing world. In many of its activities, the ISN closely collaborates with sister organizations, which also contribute financially. In total, the ISN spends annually over $1 million US from its own budget on the programs described above. CONCLUSION: The various programs and initiatives are proving helpful in advancing renal medicine in areas in need. Expansion into supporting similar programs within other medical subspecialties is being explored.

Humans↗
PubMed2003

Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States.

BACKGROUND: Recent studies have suggested that early predialysis nephrological care is associated with lower mortality; however, this hypothesis has not been tested in a population-based study. We evaluated the impact of early nephrology referral and pre-end-stage renal disease (ESRD) care on mortality risk in a national cohort of new patients starting dialysis therapy in 1996 and 1997. METHODS: Data were obtained on a subset of patients (n = 2,264; 56%) from the Dialysis Morbidity and Mortality Study Wave 2 who then were followed up for up to 2 years. Survival comparisons were made using log-rank test, then by Cox regression adjusting for demographics, comorbid medical conditions, and surrogate markers of pre-ESRD care. RESULTS: Adjusted mortality risks (relative risks [RRs]) were higher for late- (within 4 months of dialysis initiation) compared with early-referred patients at the end of 1 and 2 years of follow-up (RR, 1.68; confidence interval [CI], 1.31 to 2.15; RR, 1.23; CI, 1.02 to 1.47, respectively). Mortality risks were similarly high for the late-referred nondiabetic (RR, 2.10; CI, 1.49 to 2.94) and hemodialysis subgroups (RR, 1.72; CI, 1.25 to 2.38). Conversely, mortality risks were lower for patients who saw a nephrologist at least twice in the year before dialysis therapy initiation (RR, 0.80; CI, 0.62 to 1.03; P = 0.08] compared with those who did not. CONCLUSION: Late nephrology referral is associated with greater death risk in new patients with ESRD, and more frequent pre-ESRD care confers increased survival benefit. These findings stress the need for earlier referral of patients to nephrologists and improved pre-ESRD care for all patients approaching ESRD in the United States to improve survival. Am J Kidney Dis 41:310-318.

Cohort Studies↗
PubMed2000

Advanced practice nurses in nephrology.

With the growing shortage of nephrologists and the increasing number of end-stage renal disease patients, collaborative practice arrangements between nephrologists and advanced practice nurses (APNs) are becoming more common. This report addresses both the credentials and scope of practice of nephrology APNs. Because the APN role in nephrology is multifaceted, role responsibilities in the nephrology office, chronic dialysis unit, and acute care setting are outlined. Nephrologists and APNs have overlapping scopes of practice, and practicing collaboratively allows each health care professional to use their strengths maximally. Barriers to practice and reimbursement issues are discussed. Documentation needed to enter into collaborative practice is delineated. This includes collaborative practice agreements, scope of practice statements, prescribing protocols, hospital credentialing, and dialysis facility credentialing. The goal of the collaborative practice model is to improve traditional patient care and delivery of services. The APN's role complements that of the nephrologist and offers a unique, holistic approach to the quality of patient care that is needed in the current health care environment.

Credentialing↗
PubMed2003

The Armenian earthquake of 1988: a milestone in the evolution of nephrology.

A dreadful earthquake struck a densely populated region of Armenia on December 7, 1988. All principal determinants of structural damage and crush injury converged to magnify the dreadful outcomes of this otherwise modest earthquake, which registered 6.9 on the Richter scale. Two circumstantial events focused unprecedented world attention on this natural disaster. First, the news media, assembled to cover the historic visit of Mikhail Gorbachev to the United States, were suddenly deprived of the news they had gathered to cover when Gorbachev interrupted his visit to examine the disaster personally. As a result, the world news media channeled their collective force on covering the tragic events in Armenia. Second, an official Soviet request for dialysis assistance was delivered at the opening session of the annual meeting of the American Society of Nephrology in San Antonio on Sunday, December 11, 1988. As a result, the entire nephrology community was suddenly engulfed in the mounting worldwide enthusiasm to provide humanitarian aid. The subsequent efforts of the National Kidney Foundation and the International Society of Nephrology prompted the discipline to examine, evaluate, and establish a role for nephrologists in preparedness and response to natural disasters.

Acute Kidney Injury↗