A highly respected senior nephrologist and renowned opinion leader, who also happened to be my good old friend and colleague, asked me why I and some other academicians are involved in supporting such non-peer-reviewed journals as Renal & Urology News (RUN). My answer was simple: RUN is an effective tool for reaching out to the majority of practicing nephrologists, urologists, and other physicians who rarely read peer-reviewed journals.

In mid-July 2008, 90,000 Americans were listed by the Organ Procurement and Transplant Network (OPTN) as waiting for a deceased donor kidney. An undefined but definite cohort—estimated to be at least 3,000—of those on the wait list will die this year but might survive if suitable donor kidneys were available. Indeed, of 1,732 adults on a transplant list in Scotland, the relative risk of mortality at one year was 68% lower for deceased donor kidney transplant recipients compared with those who remained on hemodialysis (J Am Soc Nephrol. 2005;16:1859-1865).

NEPHROLOGISTS WANT to improve outcomes and quality of life for renal disease patients through research, but we are faced with major hurdles.

WITH UPPER tract transitional cell carcinoma (UT-TCC), vigilance is the watchword. Detecting this cancer earlier may directly impact patient survival. According to the American Cancer Society, 54,390 new cases and 14,100 deaths in the United States will occur during 2008. Up to 15% of all kidney cancers are UT-TCC. NMP22 BladderChek Test (Matritech) is approved by the FDA in the detection of bladder cancer.

Decreases in glomerular filtration rate (GFR) are associated with higher risks of cardiovascular events, hospitalizations, and premature death (N Engl J Med. 2004;351:1296-1305). While both patients and clinicians recognize the importance of accurate renal function assessments, most rely on a relatively qualitative categorization of chronic kidney disease (CKD) using plasma creatinine concentration alone. Since creatinine is excreted solely by the kidneys, is completely filtered, and undergoes negligible tubular secretion, serum levels enable estimations of GFR, albeit imperfectly.

Practicing evidence-based medicine can be difficult in nephrology, where randomized controlled trials are few and far between. In general, the more that trials use hard outcomes such as morbidity and mortality, the greater our confidence that the therapies will have an impact on patients' lives. Using end points such as these, however, often require large sample sizes.

In recent years, a number of studies purport to show that active surveillance with the potential for delayed treatment (AS-DT) is a feasible option for selected prostate cancer patients, namely those with low-risk tumors.

Hypertension is the most important risk factor of mortality, accounting for about 12% of all deaths worldwide. Time and again, lowering BP has proved to be beneficial in randomized controlled trials. Still, a number of questions remain about the effects of antihypertensive therapy in patient groups that are excluded from most clinical trials.

Most physicians in this country provide patient care in busy private practice offices or non-teaching hospitals. Practicing physicians often try to adhere to relevant guidelines to optimize patient care and achieve better outcomes. The guidelines, however, are usually developed by certain groups of opinion leaders and experts who are mostly, if not exclusively, academicians from renowned universities or research centers.

The 2008 Genitourinary Cancers Symposium in San Francisco featured a session on anticipating failure in the patient with advanced prostate cancer. Anthony Zietman, MD, the Jenot and William Shipley Professor of Radiation Oncology at Harvard Medical School in Boston, made his case for the use of adjuvant external beam radiation therapy. Adam Kibel, MD, associate professor of surgery in the division of urologic surgery at Washington University School of Medicine in St. Louis, argues in favor of systemic treatment.