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Donor and recipient evaluation

1. What are the various categories of living-donor transplants? Related donors: Donor and recipient are biologically related. Unrelated donors: Donor is not biologically related, but an emotional relationship exists between the donor and recipient (e.g., coworker, classmate, friend). Directed anonymous donors: Donor has no relationship to the recipient; the donor learned of the recipient’s situation and decided to donate altruistically. Undirected anonymous donors: Donor decides to…

Epidemiology and outcomes

1. What is united network of organ sharing (UNOS)? UNOS is the nonprofit, scientific and educational organization that administrates over the United States national organ registry known as the Organ Procurement and Transplantation Network (OPTN). UNOS originated as an initiative of The South-Eastern Organ Procurement Foundation (SEOPF) in 1977. SEOPF was the first organization to develop a computerized system that used medical information to match potential…

Therapeutic plasma exchange (plasmapheresis)

1. What is the definition of plasmapheresis, and when is it indicated? The term “apheresis” is Greek for “taking away” and refers to a procedure where the therapeutic removal of macromolecules from the plasma is done for therapeutic reasons. It is indicated for conditions where substances that are not removable with conventional dialysis must be removed from the blood. 2. Describe the techniques for plasma separation…

Peritoneal dialysis

Technical aspects of peritoneal dialysis 1. What is peritoneal dialysis (PD), and how does it work? PD is a means of removing waste (such as urea, creatinine, and phosphate), other solutes (i.e., sodium and chloride), and excess fluid from the body when the kidneys have failed. A sterile solution (PD fluid) containing a balanced concentration of electrolytes and an osmotically active agent is introduced into the…

Home dialysis

1. What is home hemodialysis (HHD)? HHD is a kidney replacement modality for patients with end-stage kidney disease (ESKD) that can be performed safely in the patient’s home environment. Assistance of a trained caregiver or qualified hemodialysis nurse is a requirement. The frequency of treatment for HHD can vary per individual patient. HHD can be performed as conventional HHD, with treatments 3 days a week for…

Hemodialysis

Technical aspects of hemodialysis 1. What are the components used during a hemodialysis procedure? The components needed to conduct dialysis include a dialysis machine, a method to access the patient’s arterial and/or venous system, a supply of treated water in order to make dialysate, and the dialyzer. The dialysis machine consists of two major components: (1) a blood pump and associated safety equipment for the blood…

Kidney diseases in african americans

1. What is the incidence of end-stage kidney disease (ESKD) in african americans? African Americans represent about 13% of the United States population but account for more than one-third of the ESKD population. African American adults are almost four times as likely as non-Hispanic Caucasians to develop ESKD. Among men aged 20 to 39, African Americans are approximately 15 times more likely to develop ESKD secondary…

Kidney diseases in the elderly

1. What is the prevalence of chronic kidney disease in the elderly? Approximately 11% of patients older than age 65 years are noted to have chronic kidney disease (CKD) as estimated by using the Modification of Diet in Renal Disease (MDRD) study equation in those participating in National Health and Nutrition Examination Survey III. As the proportion of elderly increases in the population as a whole,…

Sickle cell nephropathy

1. What is the pathophysiology of sickle cell disease (SCD)? Hemolysis, vasoocclusion, and ischemia reperfusion are the clinical hallmarks of SCD. The substitution of glutamate for valine at position 6 of the hemoglobin β-chain is the mutation defining hemoglobin S (HbS). HbS polymerizes when the concentration of its deoxygenated form exceeds a critical threshold. Conditions that promote HbS polymerization and red blood cell sickling include low…

Kidney disease and hypertension in pregnancy

1. What changes take place in the kidney during pregnancy? The kidney undergoes anatomic and physiologic changes during normal pregnancy. The length of the kidney increases by 1 to 1.5 cm and there is hormonally mediated dilatation of the collecting system to a volume of about 300 cc. The resulting physiologic hydronephrosis makes it difficult to diagnose obstruction by ultrasound. The glomerular filtration rate increases by…

Urinary tract infection

1. What is a urinary tract infection (UTI)? UTI is the presence of microorganisms in the urine or tissues of the normally sterile genitourinary tract. Infection may be localized to the bladder alone or involve the kidneys and, in men, the prostate. Acute uncomplicated UTI occurs in women with a normal genitourinary tract and usually manifests as acute cystitis (bladder infection or lower tract infection). These…

Tubulointerstitial diseases

Acute tubulointerstitial nephritis 1. What is acute tubulointerstitial nephritis? Acute tubulointerstitial nephritis (ATIN) is characterized by inflammation and edema in the kidney tubulointerstitium and can cause acute kidney injury (AKI). Definitive diagnosis is established by kidney biopsy, though this may not be necessary if the index of suspicion for ATIN is high. A retrospective study done by Goicoechea showed that the incidence of ATIN, particularly ATIN…

Other hereditary kidney disorders

1. What is familial or inherited hematuria? Familial (inherited) hematuria is defined as a group of genetic kidney disorders that are clinically characterized by the onset of persistent microscopic hematuria during childhood. The unifying feature of these conditions is an abnormality in the network of type IV collagen in the glomerular basement membrane (GBM). The major forms of familial hematuria are Alport syndrome and thin basement…

Cystic diseases of the kidneys

1. What are cystic diseases of the kidneys? Cystic diseases of the kidney are a heterogeneous group of disorders that can be inherited, developmental, or acquired ( Box 43.1 ). Box 43.1. Modified from Torres, V. E., & Harris, P. C. (2016). Cystic diseases of the kidney. In B. M. Brenner (Ed.), The kidney (10th ed.). Philadelphia: W. B. Saunders. Classification of Cystic Kidney Diseases Autosomal…

Fabry disease

1. What is Fabry disease? Fabry disease is a systemic, X-linked, lysosomal storage disorder that results from the deficient activity of the enzyme α-galactosidase A (α-Gal A) and the lysosomal accumulation of its primary glycolipid substrate, globotriaosylceramide (GL-3). The progressive GL-3 accumulation, particularly in vascular endothelial lysosomes, leads to ischemia and occlusion of small vessels throughout the body. Clinical onset in affected males with the Type…

Thrombotic microangiopathies

1. Define thrombotic microangiopathy. Thrombotic microangiopathy (TMA) is a pathologic description characterized by arteriole and capillary endothelial vessel wall damage that results in platelet activation, thrombosis, and damaged erythrocytes (schistocytes) leading to ischemia and organ failure. Several different clinical syndromes can present with the characteristic features of TMA. 2. What are the clinical features associated with thrombotic microangiopathy? The main clinical features of all TMA syndromes…

Kidney neoplasias

1. Describe the demographics of renal cell carcinoma (RCC). how many cases of RCC are diagnosed annually, and how many deaths are attributable to this disease? Is RCC more common in males or females? What is the median age at diagnosis of RCC? In 2016, an estimated 62,700 cases of RCC were diagnosed, and 14,240 deaths were attributable to the disease. Approximately 63% and 65% of…

Dysproteinemias or light chain diseases

Dysproteinemias 1. What is myeloma? Myeloma is a hematologic malignancy comprising about 1% of all cancers. It consists of an excess of clonally expanded cytogenetically heterogeneous bone marrow-derived plasma cells with two cardinal features: a monoclonal immunoglobulin (the paraprotein or M-protein) and/or associated light chains (LCs; kappa [κ] and lambda [λ]) with bone destruction that usually manifests as osteolytic lesions. All myeloma derives from a preclinical…

Tumor lysis syndrome

1. What is tumor lysis syndrome (TLS)? TLS is a condition in which widespread necrosis of tumor cells releases toxic amounts of intracellular contents into the circulation, resulting in acute hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury (AKI). 2. What causes TLS? TLS is usually caused by chemotherapeutic agents in patients with cancer resulting in rapid cell necrosis. Common agents implicated include cisplatin, etoposide, fludarabine,…

Onconephrology

1. What is onconephrology? Onconephrology focuses on all aspects of kidney disease in patients with malignancy, as well as areas where nephrology intersects with hematology. As the name implies, nephrologists and oncologists are well positioned to collaborate on this area of medicine. 2. What does this field of nephrology include? 1. Electrolyte disorders of malignancy 2. Secondary glomerular diseases of malignancy 3. Chemotherapy-related kidney complications 4.…