Journal of Onconephrology

Announcing the first of it's kind
Journal of Onconephrology, the official journal of C-KIN
We are hoping this journal will become THE place for the articles related to cancer and the kidney be published,

First article from 1966 that inaugurated the ASN

The field of Nephrology is not that old. ASN is going to be celebrating the 50th year of creation of the American Society of Nephrology this Fall 2016. I wanted to share the first article ever published in 1966 introducing ASN to the world. It was recently linked in ASN Kidney News.  Worth a read.
Even back then in 1966, a plea was made for early referrals for CKD, and not wait too long...

Check it out here...

IN THE NEWS: Cardiac output out and renal congestion in? what is the real cause of renal failure in CHF?

A dynamic study published in JACC might throw a curve on our thinking on heart failure and renal dysfunction. Chronic CHF( not cardiogenic shock) related renal dysfunction has been attributed by many to hypoperfusion due to impairment of cardiac output. Hanberg et al disprove this concept via an elegantly done analysis of cardiac index and renal dysfunction a registry database of CHF patients. There was no relationship that was significantly noted with cardiac index and renal dysfunction.  In this study , the patients were hospitalized for CHF, cardiac index was NOT the primary driver of renal dysfunction.

What is the major player then in the negative renal function?

Systolic Blood pressure might being low
High abdominal pressures – abdominal compartment syndrome
Renal vein congestion
Neurohormonal activation

An editorial in the same issue proposes alternate mechanism? But yet again physiology has not helped us. What was taught in textbooks and prior reviews was intuitive and perhaps it’s not that simple.  Improving forward flow might not be as important as providing “decongestion” from a kidney’s perspective.

Worth a read for the cardio-renal folks out there

In the News: Will the smart phone change Nephrology Care?

While smartphone apps have flourished in the general world we live in, Nephrology hasn’t seen direct patient care related smartphone apps. There are some great educational apps and a list of them are provided in a prior post on AJKD Blog. A survey done that was mentioned in that post focused mainly on educations of nephrology related apps.
The most recent CJASN issue presents perhaps one of the first( there might be more but not published) nephrology app that can be used in clinical practice. While this is not a randomized control trial, nor there was sustained long term follow up of these patients, this is a good start for a proof of concept for perhaps work in this area. This smartphone app targeted four behavioral elements in patients with CKD stage 4 or 5, it targeted BP, medication management, symptom assessment, and tracking laboratory results. The mean reductions in home BP readings between baseline and exit were statistically significant  and  27% with normal clinic BP readings had newly identified masked hypertension. In addition, medication errors were also identified.  An accompanying editorial also sheds some interesting thoughts on this concept. The editorial rightly addresses the downloadability of such apps. 
How many of your CKD patients own a smart phone?
If they do, how many are “techy” enough to download the app?
Mass use of such apps might be tough given the socio-economic barriers some of our patients might face.  Regardless, we need such apps and available for free for patients. Perhaps, we can teach them to download them and use them effectively to prevent re-hospitalization, medication errors, and offer and provide better patient care.