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Prostate Cancer Screening: Moving Beyond PSA

May 01, 2012

More than 1 million prostate biopsies are performed annually in the United States, predominantly driven by elevations in PSA.
 

Is U.S. Nephrology Lagging Behind?

April 01, 2012

As practicing clinicians in the United States, we generally feel privileged, with access to a highly developed and pioneering medical care system along with an advanced and cutting-edge technology in the world's largest economy.
 

Highlights of the GU Cancers Symposium

March 01, 2012

The March issue features coverage of the 2012 Genitourinary (GU) Cancers Symposium, which was held in San Francisco.
 

Lessons from "The Hemodialysis Marathon Man"

February 29, 2012

An impressive story of a dialysis survivor who watched his daughters grow and getting married, and had the joy of knowing several grandchildren.
 

Let Patients Sleep During Rounds

February 01, 2012

How often do you face with the unpleasant task of waking a sleeping patient during your busy rounds? It happens frequently to many clinicians during their inpatient rounds in the hospital.
 

Highlights of 2011, The Promise of 2012

January 01, 2012

The start of 2012 is a good time to look back on the previous year to see the current state of nephrology. What have been the important findings that occurred in the past year, and what do we have to look forward to in the year ahead?
 

Dialysis Care in the Post-Bundling Era

December 01, 2011

For the ninth straight year, I came away from Kidney Week (formerly Renal Week), the annual scientific meeting of the American Society of Nephrology, feeling badly that Renal & Urology News can only report on a fraction of the thousands of studies presented at the meeting.
 

Kidney Stone Prevention: 'Fact versus Fiction'

November 21, 2011

According to current estimates, kidney stones will develop in one in 10 people during their lifetime. This translates into nearly 30 million people in the United States. Clearly, prevention is paramount when dealing with kidney stones.
 

ACOs and Productivity Metrics in Medicine

November 01, 2011

Individuals, businesses and nations grapple with how to measure success. Are similar productivity measures warranted in medicine?
 

Some Thoughts on Patient Education

October 11, 2011

Physicians are indeed spending less face time with patients, according to studies and to what doctors have told me in conversation. One consequence of this could be less time to educate patients about their illness.
 

High BMI and Kidney Transplant Waitlisting

October 11, 2011

Many obese dialysis patients are asked to lose weight to qualify for kidney transplantation. If such usual weight reduction programs as dieting or anti-appetite medications do not work, some patients will be introduced to more aggressive interventions such as bariatric surgery.
 

Should We Start Dialysis As Late As Possible?

August 15, 2011

Traditional nephrology training makes us believe that it is good practice to start maintenance dialysis therapy sooner rather than later. Nevertheless, recent data indicate that we may encounter yet another "old-practice-was-wrong" paradigm shift.
 

Kidney Cancer vs. ESRD

, July 19, 2011

Incidentally detected renal tumors are increasingly diagnosed in patients with chronic kidney disease.
 

CKD Stage 3 Needs To Be Redefined

April 18, 2011

Nephrologists should rethink the screening level and offer a more conservative and meaningful cutoff level, such as an eGFR of 45.
 

Are All Acute Kidney Injuries "Acute on Chronic"?

March 14, 2011

Practicing nephrologists are frequently consulted to evaluate acute kidney injury (AKI) as inpatient cases.
 

The Negative Prostate Biopsy Dilemma

February 24, 2011

The role of PSA as a cancer screening tool has recently been evaluated by several large high profile studies with varying interpretations of the data. Regardless of where one stands on the debate, among the clinical dilemmas of PSA-based screening is the negative biopsy conundrum where the reality remains that the best one can offer is, "Good news Mr. Smith, I don't think you have prostate cancer."
 

The Pros and Cons of Interventional Nephrology

November 11, 2010

The advantages of this emerging specialty are clear to those involved in vascular access care, but some potential downsides must be considered.
 

Nephrology In Canada Is Well Supported

June 10, 2010

Many Americans harbor fears about the Canadian health care system, and I would like to clear up some misconceptions.
 

A Call to Service For Nephrologists

April 26, 2010

The pending legislation on health care reform can be polarizing, but the motivation supporting it is not.
 

Renin Mutations As a Cause of Inherited Interstitial Kidney Disease

April 01, 2010

An international research team have identified a number of families suffering from a mutation in the signal peptide of the renin gene that lead to the development of autosomal dominant CKD.
 

Paid for Good Outcomes Measures

March 26, 2010

Who could have guessed that one day physicians would be paid based on the outcomes of patients under their care? This is the imminent reality in nephrology.
 

Relief for Haiti's ESRD Patients

February 16, 2010

As this issue goes to press, thousands of rescue personnel from the United States and other countries throughout the world are engaged in relief efforts in earthquake-ravaged Haiti, where the death toll exceeded 100,000.
 

If Fat is Good, Is Muscle Better?

January 27, 2010

One of recent challenges in nephrology and other internal medicine subspecialties is providing care to an increasing number of patients with chronic disease states and wasting syndrome.
 

The '30-20-10' Rule for Renal Care

, , January 22, 2010

Nephrologists propose critical action eGFR thresholds to guide management of kidney disease patients.
 

A More Rational Approach To Renal Mass Surgery

November 18, 2009

In the absence of level I evidence, physician treatment recommendations are subject not only to the objective (interpretations of the cohort literature and practice guidelines) but also the subjective (training patterns, comfort levels, biases and individual experiences).
 

Bundling: A Venture into the Unknown

October 08, 2009

Many nephrologists feel increasingly bewildered by heightened discussion about the upcoming bundling system for dialysis patients. The dialysis industry is a unique and giant enterprise serving nearly a half million Americans with end-stage renal disease (ESRD).
 

Who 'Owns' Health-Care Cost Decisions?

August 18, 2009

The imperfections of our nation's delivery of health care have long been recognized. From poor access for the underinsured and uninsured to potential overutilization by the worried well-insured, the issue has risen to political prominence, with its costs front and center.
 

Consider Radiation-Sparing Stone Follow-Up

June 05, 2009

Kidney stone disease represents a substantial portion of the urologist's surgical practice.
 

Are You Ready to Lead?

April 29, 2009

In light of changes in Medicare policies related to ESRD, nephrologists will be called on to play an expanded leadership role in dialysis centers.
 

Bring Kidney Care into the 21st Century

April 03, 2009

The growth in the number of patients with end-stage renal disease (ESRD) has tapered and is being offset by continuous improvements in survival. The result is a continued steady increase in the number of patients requiring renal replacement therapy.
 

The Need for Medical Liability Reform

February 23, 2009

Two articles in the December 2008 issue of Renal & Urology News add to mounting evidence of the need for medical liability reform, specifically no-fault compensation for medical injuries.
 

Now Is The Time For Universal Health Care

February 03, 2009

The Medicare End-Stage Renal Disease (ESRD) Program is one of the most significant developments in the history of U.S. health care and an unqualified success.
 

Funding Prostate Cancer Prevention Efforts

January 16, 2009

The risk of a man's developing prostate cancer is approximately 18%. Whereas it has been estimated that as much as 60% of this risk is due to environmental exposure (J Urol. 2007;178:S9-S13), developing strategies to mitigate this risk is an important public heath concern.
 

Important Lessons from ONTARGET

January 09, 2009

In the past year, an important landmark study demonstrated therapeutic equivalence of the ACE inhibitor ramipril and the angiotensin receptor blocker (ARB) telmisartan in reducing the risk of all forms of atherosclerotic events.
 

Taking on the Issue of Transplant Tourism

November 24, 2008

As the U.S. waiting list for kidney transplants grows, and with it the potential for longer waiting times, so might the temptation among end-stage renal disease patients to travel abroad for a transplant.
 

The Need for Renal & Urology News

October 01, 2008

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.
 

Marketing Donor Kidneys: A Personal Viewpoint

October 01, 2008

In mid-July 2008, 90,000 Americans were listed by the Organ Procurement and Transplant Network (OPTN) as waiting for a deceased donor kidney.
 

The Challenges of Nephrology Research

October 01, 2008

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

Urine Test Detects Upper Tract TCC

September 01, 2008

With upper tract transitional cell carcinoma (UTTCC), 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.
 

CKD: Speaking the Same Language

September 01, 2008

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).
 

In Clinical Trials, Does One Size Fit All?

August 28, 2008

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.
 

Prostate Cancer and the Younger Patient

July 21, 2008

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: Still Public Enemy No. 1

July 15, 2008

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.
 

The Guideline Disconnect

May 06, 2008

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.
 

Point/Counterpoint: How to Treat Advanced Prostate Cancer—Two Options

May 01, 2008

The 2008 Genitourinary Cancers Symposium in San Francisco featured a session on anticipating failure in the patient with advanced prostate cancer.
 

The Perils of 'Nephron-Wasting' Surgery

, May 01, 2008

The broad application of cross-sectional imaging has led to the incidental discovery of small renal masses (SRM) as the most common presentation for localized kidney cancer.
 

The Kidney Transplant Tradeoff

April 10, 2008

Research developments that have implications for nephrology and urology certainly are not limited to the meetings and journals targeting these specialties. That is why our news coverage extends to meetings that nephrologists and urologists usually do not attend and journals they usually do not read.
 

Nature's Pharmacy

February 26, 2008

Through millions of years of evolution, nature has created a fantastic array of plant and animal species, each with specific adaptations to survive. These adaptations have resulted in an incalculable number of organic compounds unique to each living thing.
 

Be Ready to Give Up Beliefs

January 01, 2008

Physicians practice medicine with great sincerity. They want to help their sick patients get well and stay well, and they dole out treatments in good faith and with the best of intentions. From time to time, however, data emerge suggesting that the treatments upon which they rely are of little or no benefit.
 

Expanding the Use of ECD Kidneys

December 01, 2007

Two articles in this issue relay new findings on one of the most pressing and controversial issues in nephrology: increasing the number of donor kidneys available for transplantation. The solution examined in each article is the use of more kidneys from expanded criteria donors (ECD).
 

Robot Surgery Assistants Get 3-D View

, , , November 01, 2007

During the past five years, the da Vinci robot has increasingly been used to perform radical prostatectomies. This robotic technology has revolutionized prostate cancer surgery.
 

Shaping the Future of Kidney Care

, November 01, 2007

The kidney-care community can point to more than 30 years of clinical accomplishments. In particular, the past 10 years have been marked by steady improvement in patient access to dialysis centers and improvement in clinical outcomes. Still, important challenges remain. The renal community must understand these challenges and continue the tradition of developing innovative programs to assist nephrologists in overcoming them in the future.
 

A Closer Look at Home Hemodialysis

October 23, 2007

As patients, physicians, dialysis providers, and payers search for more favorable outcomes in patients with end-stage renal disease (ESRD), alternative dialysis regimens have gained popularity. Among these therapies are dialysis treatments that are performed more frequently, for longer periods of time, and/or at the patient's home.
 

The Anemia Management Controversy

October 19, 2007

On September 11, 2007, an FDA panel of health experts declined to recommend the quasi-expected restrictions on the use of the erythropoietin stimulating agents (ESA) in CKD patients.
 

Maximizing SWL Outcomes for Calculi

September 01, 2007

UROLITHIASIS afflicts 7%-13% of the population and has a recurrence rate of up to 50% at five years. In the United States, the economic burden of treatment and lost productivity was estimated at $2.1 billion in 2001. Stone size and location determined from non-contrast CT and plain radiographs have long been used to triage patients for either shock wave lithotripsy (SWL) or endoscopic management.
 

"Good to Great" — Important Lessons in Medicine

September 01, 2007

While comparing summer "must read" lists, a friend suggested I pick up a copy of "Good to Great" (Jim Collins, Harper Collins 2001). My friend argued the premise of this book (that companies and indivi-duals who leap from "good to great" follow a consistent formula) has important implications in medicine.
 

Phosphate Binders Not the Whole Answer

August 01, 2007

Nephrologists and dietitians spend a significant amount of their time managing hyperphosphatemia. Phosphorus retention, which occurs in moderate to advanced CKD, is thought to contribute to secondary hyperparathyroidism and excessive vascular calcification.
 

Why the OR Just Doesn't Pay

July 01, 2007

Clinicians in virtually every medical and surgical specialty would have little trouble citing services for which they considered third-party reimbursement woefully inadequate for the time involved. Medicare reductions in payments for commonly performed procedures have forced physicians to change their practices so that they can pay for ever-increasing office expenses and still make a decent living.
 

Respect for the Placebo Effect

June 01, 2007

The placebo is an integral part of clinical research, helping investigators arrive at the true effect of an experimental treatment.
 

Targeted Therapies Include Targeted Surgery

May 01, 2007

The term "targeted therapy" has entered the oncologic lexicon over the past five years, with primary applications in medical and radiation oncology.
 

How to Control BP in Dialysis Patients

April 24, 2007

The characteristics of hypertension in hemodialysis patients differ from those in the general population. In dialysis patients, accelerated age-related changes in vascular stiffness, combined with factors peculiar to uremia, contribute to a loss of large and small vessel distensibility.
 

Meeting Size Doesn't Matter

April 01, 2007

Renal & Urology News provides news coverage of about two dozen national and international meetings annually. Some of these meetings are a lot smaller than the annual meetings of the American Society of Nephrology and American Urological Society, but that does not mean we take them less seriously from a news standpoint.
 

New Surgical Options for BPH Must Measure Up

March 01, 2007

The past two decades have witnessed the introduction a dizzying array of minimally-invasive surgical alternatives to the gold standard treatments for BPH—transurethral resection of the prostate (TURP) and the open simple prostatectomy.
 

Anecdotes, Outcomes, and Evidence-Based Medicine

February 01, 2007

Go to a grand rounds or medical conference and listen. What do you hear? In most discussions of patient care, clinicians relate compelling anecdotes typically beginning with "I once had a patient who..." Fill in the blank.
 

Kidney Bone Disease Field Heats Up

, January 01, 2007

Nephrologists have been well aware that renal osteodystrophy, also known as kidney bone disease, is a common complication of advanced CKD (stages 3 to 5).
 

Anemia Studies Not the Final Word

January 01, 2007

The recent publication of the CHOIR and CREATE studies in the New England Journal of Medicine questioning hemoglobin targets in dialysis patients (see article on page 19) have resulted in intense scrutiny of the relationship between Amgen, dialysis organizations, and physicians in the management of anemia. Last month, the U.S. House Ways and Means Committee held hearings on the matter. What is all the fuss about?
 

No Borders for Pathogens

December 01, 2006

For centuries, human beings have spread diseases long distances through their travels. Yellow fever and the mosquitoes that transmit it, for instance, are thought to have originated in Africa and been introduced to the New World by slave ships in the 1500s. The 1918 influenza pandemic illustrates how contagious diseases can spread throughout the world.
 

Going Beyond Machines

November 01, 2006

Most patients with end-stage renal disease (ESRD) are consigned to life on dialysis. Most undergo in-center hemodialysis three times a week, greatly diminishing their quality of life. Moreover, dialysis patients have a relatively high mortality. In 2003, three-year survival of dialysis patients was 56%, according to the U.S. Renal Data System.
 

What Will Become of the Scalpel?

October 01, 2006

Two articles in this issue report on outcomes in patients who underwent holmium laser enucleation for enlarged prostates, called HoLEP for short.
 
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