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1.
Rev Med Liege ; 75(5-6): 336-343, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32496676

RESUMO

Chronic kidney disease (CKD) impairs the quality of life and increases the risk for cardiovascular morbimortality. Intensive research is conducted in order to slow down CKD development and progression. During the past decade, a better understanding of the pathophysiological mechanisms of glomerular diseases has highlighted the benefits of rituximab. Progresses have also been made in the understanding of the mechanisms of autosomal polycystic kidney disease, the most frequent inherited kidney disease. These observations led to the discovery and validation of tolvaptan, a blocker of the V2 receptor of the antidiuretic hormone as an innovative treatment. Type 2 diabetic disease is the leading cause worldwide of endstage kidney disease and dialysis. The development of new drugs, such as the gliflozins (inhibiting the sodium glucose reabsorption in the proximal tubule), has contributed to an improvement in the management of the cardiovascular and renal risks especially reducing congestive heart failure rate. Another important progress in nephrology since the beginning of the new century concerns a more precise estimation of the kidney function, which allows to better evaluate the slope of CKD progression and test the influence of different therapeutic approaches aiming at correcting anemia, hyperkalemia, metabolic acidosis and disturbances of calcium and phosphate. The present review summarizes all of these major advances in the field of CKD diagnosis and treatment, and envisions the future of nephrology for the next decade.


Assuntos
Nefrologia , Insuficiência Renal Crônica , Progressão da Doença , Taxa de Filtração Glomerular , Humanos , Rim , Nefrologia/tendências , Qualidade de Vida , Insuficiência Renal Crônica/terapia , Tolvaptan
4.
G Ital Nefrol ; 37(2)2020 Apr 09.
Artigo em Italiano | MEDLINE | ID: mdl-32281765

RESUMO

This paper by Mauro Sasdelli describes the dawn and the development of nephrology first in Bologna, where Sasdelli studied in the nineteen-sixties, and later in Arezzo; the author tells us of the dedication, the enthusiasm, the hard work of all involved, but also of their conflicts and banter. The paper describes the important contributions to nephrology made by prominent personalities such as Domenico Campanacci, Vittorio Bonomini and Pietro Zucchelli, not only at a local level but also more broadly. Finally, text and images of this "personal history" can also be read as the integration of an article published on this same journal in 2016, "The dawn of Nephrology and Dialysis in Bologna with Vittorio Bonomini and Pietro Zucchelli" (Giornale Italiano di Nefrologia, vol. 33, n. 4).


Assuntos
Nefrologia/tendências , Humanos , Itália
6.
PLoS One ; 15(2): e0228890, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053647

RESUMO

INTRODUCTION: The global nephrology workforce is shrinking and, in many countries, is unable to meet healthcare needs. Accurate data pertaining to human resources in nephrology in South Africa is lacking. This data is critical for the planning and delivery of renal services and the training of nephrologists in South Africa to meet the challenge of the growing burden of chronic kidney disease. METHODS: A cross-sectional study of adult and paediatric nephrologists currently delivering nephrology services in South Africa was conducted. Participants were identified using various data sources, including the register of the Health Professions Council of South Africa. This cohort of doctors was described in terms of their demographics and distribution. A survey was then conducted among these nephrologists to collect additional information on their training, scope of practice, job satisfaction, challenges and future plans. Finally, two focus group interviews were conducted to probe themes identified from the survey data. RESULTS: A total of 120 adult nephrologists and 22 paediatric nephrologists were identified (an overall density of 2.5 per million population). There is a male predominance (66%) and the median age is 45 years. The bulk of the workforce (128 nephrologists, 92%) is distributed in three of the nine South African provinces, and two provinces have no nephrologist at all. The survey was completed by 57% of the nephrologists. Most reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. A total of 13 nephrologists participated in the focus group interviews. The themes which were identified included that of a rewarding profession, an overall shortage of nephrologists, poor career planning, a need for changes to nephrologists' training, excessive workloads with inadequate remuneration, and challenging work environments. CONCLUSION: There are insufficient numbers of nephrologists in South Africa, with a markedly uneven distribution amongst the provinces and healthcare sectors. Qualitative data indicate that South African nephrologists are faced with the challenges of a high workload, obstructive policies and unsatisfactory remuneration. In the public sector, a chronic lack of nephrologist posts and other resources are additional challenges. A substantial proportion of the workforce is contemplating emigration.


Assuntos
Nefrologia/métodos , Nefrologia/tendências , Recursos Humanos/tendências , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Médicos , Setor Privado , Setor Público , África do Sul , Inquéritos e Questionários , Carga de Trabalho
7.
Rev Med Suisse ; 16(676-7): 63-67, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961087

RESUMO

Impact of gliflozines and rituximab in the treatments of diabetic and membranous nephropathies respectively has been confirmed. Roxadustat may be the new promising treatment of renal anemia. Long-acting erythropoietins may be associated with a higher death rate than short-acting ones in hemodialysis patients. Kidneys of HCV-seropositive donors can be proposed to any wait-listed patient for renal transplantation. Immunosupression minimizing the use of calcineurin inhibitors may be achieved with an everolimus-based protocol.


Assuntos
Nefropatias , Transplante de Rim , Nefrologia , Humanos , Rim , Nefrologia/tendências , Diálise Renal
9.
Am J Kidney Dis ; 74(6): 803-810, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31451330

RESUMO

Artificial intelligence is playing an increasingly important role in many fields of medicine, assisting physicians in most steps of patient management. In nephrology, artificial intelligence can already be used to improve clinical care, hemodialysis prescriptions, and follow-up of transplant recipients. However, many nephrologists are still unfamiliar with the basic principles of medical artificial intelligence. This review seeks to provide an overview of medical artificial intelligence relevant to the practicing nephrologist, in all fields of nephrology. We define the core concepts of artificial intelligence and machine learning and cover the basics of the functioning of neural networks and deep learning. We also discuss the most recent clinical applications of artificial intelligence in nephrology and medicine; as an example, we describe how artificial intelligence can predict the occurrence of progressive immunoglobulin A nephropathy. Finally, we consider the future of artificial intelligence in clinical nephrology and its impact on medical practice, and conclude with a discussion of the ethical issues that the use of artificial intelligence raises in terms of clinical decision making, physician-patient relationship, patient privacy, and data collection.


Assuntos
Algoritmos , Inteligência Artificial , Nefrologia/métodos , Melhoria de Qualidade , Feminino , Previsões , Humanos , Aprendizado de Máquina , Masculino , Nefrologia/tendências
11.
J Am Soc Nephrol ; 30(7): 1147-1150, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31208985
12.
J Vasc Access ; 20(6): 740-745, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31144566

RESUMO

BACKGROUND: The creation and maintenance of dialysis vascular access is associated with significant morbidity. Structured management pathways can reduce this morbidity, yet practice patterns in Australia and New Zealand are not known. We aimed to describe the arteriovenous access practices in dialysis units in Australia and New Zealand. METHODS: An online survey comprising 51 questions was completed by representatives from dialysis units from both countries. In addition to descriptive analysis, responses were compared between units inside and outside of major cities. RESULTS: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 38% of dialysis units in Australia and New Zealand. While 94% of units provided pre-dialysis education, only 60% reported a structured pre-dialysis pathway and 69% had a dedicated vascular access nurse. Most units routinely monitored fistula/graft function using flow rate measurement (73%) or recirculation studies (63%). A minority used routine ultrasound (35%). Thrombectomy, fistuloplasty and peritoneal dialysis catheter insertion were rarely performed by nephrologists (4%, 4% and 17% of units, respectively). Units outside of a major city were less likely to have access to a local vascular access surgeon (6/13 (46%) vs 35/35 (100%), P < 0.001). There were no other significant differences between units on the basis of location. CONCLUSION: Much variation exists in unit management of arteriovenous access. Structured pre-dialysis pathways and dedicated vascular access nurses may be underutilised in Australia and New Zealand. The use of regular access blood flow measurement and ultrasound is common in both countries despite a lack of data supporting its effectiveness. There is room for both practice improvement and a need for further evidence to ensure optimal arteriovenous access care.


Assuntos
Derivação Arteriovenosa Cirúrgica/tendências , Implante de Prótese Vascular/tendências , Nefrologistas/tendências , Nefrologia/tendências , Recursos Humanos de Enfermagem/tendências , Padrões de Prática Médica/tendências , Diálise Renal/tendências , Cirurgiões/tendências , Austrália , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Nova Zelândia
13.
BMC Nephrol ; 20(1): 111, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935367

RESUMO

Natalina Tomilina, a pioneer of Russian nephrology, is a clinician, researcher, teacher, organizer, leader, and a real pioneer, who has worked in nephrology from the very beginning of its development in Russia and continues to inspire new generations of Russian nephrologists. Her interests are very broad: from the physiology and pathophysiology of water and electrolyte balance and tubular dysfunctions to the management of transplant rejection, and from nephropathology to the treatment of idiopathic glomerulonephritis and ANCA-associated vasculitis…. to name a few. She implemented peritoneal dialysis, started first ICU for kidney patients in Russia, opened the door for the international communications, initiated a registry of the patients receiving RRT, and she never stopped seeing patients with kidney problems. In the interview on can find not only the story of her professional life, but also standpoint and philosophy of a great personality. Answering the question about emigration she said: "I never wanted to leave - I have to work at home, where I know and understand almost everything about my patients. Don't talk about prosperity, prosperous life sooner or later becomes boring. Prosperity is not the main point, and this is not prosperity, what gives you satisfaction. I feel that one should live in the place where he or she has an opportunity for personal fulfillment ad maximum". Her personal fulfillment is 100 % indeed.


Assuntos
Nefrologia , Médicas , Empoderamento , Humanos , Liderança , Nefrologia/educação , Nefrologia/métodos , Nefrologia/tendências , Federação Russa
14.
J Vasc Access ; 20(1_suppl): 35-37, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032730

RESUMO

In Dr Ohira's era, hemodialysis was done using an external arteriovenous shunt. External arteriovenous shunts surely made repeated hemodialysis possible, but they also brought about serious complications which necessarily produced the arteriovenous fistula. Arteriovenous fistula is definitely the most important contribution to long-term survival of the hemodialysis patient. Hemodialysis therapy soon became very common, so that various kinds of patients appeared for it. Then came the era of arteriovenous grafts, because many patients lost good vessels in order to create the arteriovenous fistula. More grafts are now becoming available, which are made from different materials and in different forms, thus creating greater expectations for the future. Unfortunately, at this time, the revolutionary vascular access surpassing the arteriovenous fistula has yet to appear and we must continue to make proper application of the arteriovenous fistula. Vascular access is surely one of the important factors to assure a smooth dialysis life for patients. So, we must recognize that we play an important role in the dialysis patients' life. It is interesting to note that in every country, medical care exceeds physical care. This means that the mental factor somewhat compensates for the physical factor. Dr Ohira was a vascular surgeon, but he was also interested in the activities of daily living and quality of life, which must be one of the most delicate fields in medicine.


Assuntos
Derivação Arteriovenosa Cirúrgica/história , Implante de Prótese Vascular/história , Nefrologia/história , Diálise Renal/história , Atividades Cotidianas , Derivação Arteriovenosa Cirúrgica/tendências , Implante de Prótese Vascular/tendências , Efeitos Psicossociais da Doença , História do Século XX , História do Século XXI , Humanos , Japão , Nefrologia/tendências , Qualidade de Vida , Diálise Renal/tendências , Resultado do Tratamento
18.
Rev Med Suisse ; 15(N° 632-633): 69-73, 2019 Jan 09.
Artigo em Francês | MEDLINE | ID: mdl-30629374

RESUMO

Major advances in the treatment of ANCA associated-renal vasculitides, IGA nephropathy and renal autosomal dominant polycystic disease were published within the past year. There is neither clear benefit of early initiation of renal replacement therapy in the intensive care unit nor with the use of chloride-poor solutions to prevent kidney failure. Maintenance parenteral iron supplementation in hemodialysis patients is neither associated with infectious nor cardiovascular risks. Cognitive decline may be more associated with hemodialysis than peritoneal dialysis. In transplantation, the persistence of complement-binding donor-specific antibodies after treatment is predictor of graft loss. Tocilizumab is a promising treatment for chronic antibody-mediated rejection.


Assuntos
Falência Renal Crônica , Transplante de Rim , Nefrologia , Diálise Peritoneal , Humanos , Falência Renal Crônica/terapia , Nefrologia/tendências , Diálise Renal , Terapia de Substituição Renal
19.
Nephrology (Carlton) ; 24(3): 279-286, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30239064

RESUMO

There have been few new therapies for patients with chronic kidney disease in the last decade. However, the management of patients affected by genetic kidney disease is rapidly evolving. Inherited or genetic kidney disease affects around 10% of adults with end-stage kidney disease and up to 70% of children with early onset kidney disease. Advances in next-generation sequencing have enabled rapid and cost-effective sequencing of large amounts of DNA. Next-generation sequencing-based diagnostic tests now enable identification of a monogenic cause in around 20% of patients with early-onset chronic kidney disease. A definitive diagnosis through genomic testing may negate the need for prolonged diagnostic investigations and surveillance, facilitate reproductive planning and provide accurate counselling for at-risk relatives. Genomics has allowed the better understanding of disease pathogenesis, providing prognostic information and facilitating development of targeted treatments for patients with inherited or genetic kidney disease. Although genomic testing is becoming more readily available, there are many challenges to implementation in clinical practice. Multidisciplinary renal genetics clinics serve as a model of how some of these challenges may be overcome. Such clinics are already well established in most parts of Australia, with more to follow in future. With the rapid pace of new technology and gene discovery, collaboration between expert clinicians, laboratory and research scientists is of increasing importance to maximize benefits to patients and health-care systems.


Assuntos
Testes Genéticos/métodos , Nefropatias , Administração dos Cuidados ao Paciente/tendências , Austrália/epidemiologia , Aconselhamento Genético , Humanos , Nefropatias/congênito , Nefropatias/epidemiologia , Nefropatias/genética , Nefrologia/métodos , Nefrologia/tendências , Análise de Sequência/métodos , Análise de Sequência/tendências
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