Forthcoming Issues
Vascular Medicine (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - May 30, 2023 Category: Primary Care Source Type: research
Contributors
JACK ENDE, MD, MACP (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - May 30, 2023 Category: Primary Care Source Type: research
Contents
Jack Ende (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - May 30, 2023 Category: Primary Care Source Type: research
Kidney Health and Disease in 2023: An Update
Chronic kidney disease (CKD) remains a major health issue in the United States with up to 14% of the adult population having a low estimated glomerular filtration rate (GFR), albuminuria, or both based on recent data by the US Renal Data System, which is overseen by the National Institutes of Health. Diabetes and hypertension are the most common drivers of CKD and are increasing in our adult and pediatric population, as is obesity. These conditions are more common in patients from disadvantaged backgrounds, and in recent years, even our diagnostic methods have come under scrutiny for perpetuating that challenge. (Source: M...
Source: Medical Clinics of North America - April 24, 2023 Category: Primary Care Authors: Jeffrey M. Turner, Ursula C. Brewster Tags: Preface Source Type: research
Pregnancy in Chronic Kidney Disease
Women pursue pregnancy with comorbidities such as hypertension and kidney disease, necessitating primary care physicians to remain up to date with current clinical practice. Hypertensive disorders of pregnancy pose risks to the pregnancy and to the woman in the short and long term. These risks and their management are detailed in this review. Normally, pregnancy is associated with hemodynamic and kidney-specific changes. Here the authors discuss these changes and review the impact and management of pregnancy-related acute kidney injury, chronic kidney disease, and dialysis in pregnant patients. Kidney transplant recipients...
Source: Medical Clinics of North America - April 21, 2023 Category: Primary Care Authors: Arundati Rao, Ursula C. Brewster Source Type: research
Hepatorenal Syndrome
Hepatorenal syndrome (HRS) is a primarily functional form of acute kidney injury (AKI) that develops in patients with decompensated cirrhosis. The pathophysiologic cascade that leads to HRS begins with pooling of blood in the splanchnic system, resulting in a decrease in effective circulating arterial volume. The definitive treatment of HRS is liver transplantation. When this is not possible, HRS is treated with a combination of vasoconstrictor agents and intravenous albumin. Although the combination of midodrine and octreotide is used in the United States, the recently approved terlipressin, an analog of vasopressin, is l...
Source: Medical Clinics of North America - April 20, 2023 Category: Primary Care Authors: Justin M. Belcher Source Type: research
Early Detection of Kidney Disease
Kidney disease is often silent, but then it ’s not. There may be no warning signs or symptoms that a patient has lost substantial renal function until their disease is so advanced that life-altering renal replacement therapy must at least be considered. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 20, 2023 Category: Primary Care Authors: Jack Ende Tags: Foreword Source Type: research
Onco-Nephrology
Patients with cancer may develop kidney disease with a variety of different clinical manifestations including acute kidney injury, chronic kidney disease, hypertension, proteinuria and electrolyte disturbances. Onco-nephrology is the subspecialty of nephrology that diagnoses and manages kidney disease in patients with cancer. In this article, we review major topics in Onco-Nephrology that may be encountered by the general internist. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 19, 2023 Category: Primary Care Authors: Niloufarsadat Yarandi, Anushree C. Shirali Source Type: research
Secondary Hypertension Overview and Workup for the Primary Care Physician
Secondary hypertension occurs in 5% to 10% of all patients with hypertension. Given the majority of patients with hypertension will not have a secondary cause, only select patients with specific characteristics should be screened. The causes include a range of abnormalities, some are quite rare, such as pheochromocytoma, while others are much more common, such as chronic kidney disease. When considering which disorders to test for, it is important to incorporate the clinical history, family history, and prevalence of each disease. Treatment is specific to the underlying cause and includes medications, procedures, surgery, ...
Source: Medical Clinics of North America - April 18, 2023 Category: Primary Care Authors: Jeffrey M. Turner, Mikhail Dmitriev Source Type: research
Updates in Cardiorenal Syndrome
Cardiorenal syndrome is a term that refers to a collection of disorders involving both the heart and kidneys, encompassing multi-directional pathways between the 2 organs mediated through low arterial perfusion, venous congestion, and neurohormonal activation. The pathophysiology is complex and includes hemodynamic and neurohormonal changes, but inconsistent findings from recent studies suggest this is very heterogenous disorder. Management for ADHF remains focused on decongestion and neurohormonal blockade to overcome the intense sodium and fluid avidity of the CRS. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 15, 2023 Category: Primary Care Authors: Wendy McCallum, Jeffrey M. Testani Source Type: research
Overview of, and Preparations for, Dialysis
Chronic kidney disease (CKD) is a progressive condition which is defined by decreased kidney function evidenced by a glomerular filtration rate (GFR) less than 60 mL/min per 1.73 m2 or markers of kidney damage, or both, for at least 3 months, regardless of the underlying cause. The 5 stages of CKD are based on the estimated GFR. Patients with CKD have significantly higher rates of morbidity, mortality, hospitalization, and health care utilization. Renal replacement therapy in the form of dialysis or kidney transplant is the life-sustaining treatment for patients with kidney failure. Predialysis education helps patients mak...
Source: Medical Clinics of North America - April 14, 2023 Category: Primary Care Authors: Maryam Gondal Source Type: research
Chronic Kidney Disease Stage 5
Chronic kidney disease (CKD) is a progressive condition which is defined by decreased kidney function evidenced by a glomerular filtration rate (GFR) less than 60 mL/min per 1.73 m2 or markers of kidney damage, or both, for at least 3 months, regardless of the underlying cause. The 5 stages of CKD are based on the estimated GFR. Patients with CKD have significantly higher rates of morbidity, mortality, hospitalization, and health care utilization. Renal replacement therapy in the form of dialysis or kidney transplant is the life-sustaining treatment for patients with kidney failure. Predialysis education helps patients mak...
Source: Medical Clinics of North America - April 14, 2023 Category: Primary Care Authors: Maryam Gondal Source Type: research
Overview of Renal Transplantation for Primary Care Physicians
This article reviews the role of the primary care office in helping streamline the pretransplant evaluation process and long-term posttransplant care. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 14, 2023 Category: Primary Care Authors: Priyanka Jethwani Source Type: research
Nephrotic Syndrome for the Internist
Nephrotic syndrome (NS) is a key clinical entity for the internist to recognize and understand. A wide range of infectious, metabolic, malignant, and autoimmune processes drive nephrosis, leading to a syndrome defined by proteinuria, edema, and hypoalbuminemia. NS occurs due to increased permeability to proteins at the level of the glomerulus, which allows for passage of albumin and other proteins into the urine. Proteinuria leads to a cascade of clinical complications characterized by fluid accumulation, kidney inflammation, and dysregulation of coagulation and immunity. In this article, the authors review the clinically ...
Source: Medical Clinics of North America - April 8, 2023 Category: Primary Care Authors: Maria Jose Zabala Ramirez, Eva J. Stein, Koyal Jain Source Type: research
Diagnosis of Chronic Kidney Disease and Assessing Glomerular Filtration Rate
Chronic kidney disease (CKD) is a silent progressive disease. It is diagnosed by assessing filtration and markers of kidney damage such as albuminuria. The diagnosis of CKD should include not only assessing the glomerular filtration rate (GFR) and albuminuria but also the cause. The CKD care plan should include documentation of the trajectory and prognosis. The use of a combination of serum cystatin C and creatinine concentration offers a more accurate estimation of GFR. Social determinants of health are important to address as part of the diagnosis because they contribute to CKD disparities. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 7, 2023 Category: Primary Care Authors: Abinet M. Aklilu Source Type: research
