Symplur don't lie
NephJC number 20 had the second most tweets and the third most participants. Thanks everyone for participating.
Live from San Diego it's Claudio Ronco and John Kellum
Discussing biomarkers.
KDIGO AKI staging
Tonight's journal club requires knowledge of the KDIGO acute kidney injury stages. These are nearly direct translations from the previous AKI staging systems.
- RIFLE: the first system. KDIGO 1, 2, 3 roughly corresponds to R, I, F. The primary difference is KDIGO categorizes people with just a 0.3mg/dL rise in Cr as AKI, RIFLE does not.
- AKIN: As far as I can see AKIN 1, 2, 3 is identical to KDIGO 1, 2, 3.
New for NephJC tonight: Topics
In case you haven't signed up for our mailing list (really - why not? go there and do it now!) - We are going deep on the FDA approved NephroCheck™, a new test for the early diagnosis of AKI. This is not industry sponsored BS, just honest, crowd-sourced, EBM.
For this #NephJC we have three topics we want to discuss:
*please preface your tweets with the topic: i.e. T0, T1 and so on*
Topic Zero: How are you currently diagnosing AKI?
- Is it all FENa and a microscope slide?
- What do you think of the KDIGO AKI stages?
- How do you use oliguria?
Topic 1: Evaluate their strategy for developing a novel test for AKI.
Three studies in 2 papers:
Discovery: the scientists tested 340 biomarkers and came up with a pair that performed best. N=522.
Sapphire: validated the biomarker from Discovery in a unique cohort. N=744.
Topaz: A separate study just to validate the results of Sapphire. N=420.
Is this a compelling story line? Is this a fair way to discover and validate a test? Do you agree with the conclusions?
Topic 2: Evaluating a test.
- On ROC the area under the curve was 0.82. Good enough?
- Two cutoffs are provided, one is sensitive (92%) and the other is specific (95%). How will you use that?
Topic 3: So what?
- How will having a 12 hour lead time change your management?
- Should we expect trials designed to change the course of AKI to use NephroCheck™?
GMT NephJC gaining steam
Tom Oates and his merry gang of GMT chatters shattered previous records for the Euro/Afro chat. Great work guys!
Not quite up to the pace of the western hemisphere, but gaining fast.
In a related note, NephJC.com reached 4,000 page views in a month for the first time in January.
Follow-up from the Meso-American Nephropathy NephJC
From the International Journal of Occupational and Environmental Health comes this article looking at Changes in kidney function among Nicaraguan sugarcane workers. The article is behind a paywall but according to the NPR article it exonerates the fertilizers and pesticides and adds to the data on chronic and recurrent dehydration as the culprit:
“But this new study casts doubt on that theory. It found that field workers whose primary jobs were spraying for weeds and pests (and who thus had the most contact with agricultural chemicals) had the least decline in kidney function over the course of the harvest.
The researchers also found that dehydration among workers with the most physically demanding job — cutting cane — could contribute to the illness.”
I found this bit interesting:
“Cutters who drank more of a generic energy drink while on the job had less of a drop in kidney function than co-workers who drank less of the beverage.”
If the energy drink is protective that seems to counter the fructose/uric acid hypothesis that Dr. Johnson was proposing in his article. This continues to be one of the most interesting stories in nephrology.
Tweet of the night
We had a great NephJC last night. We had a new contributor who was excellent, Eric Weinhandl of Minnesota.
Dr. Weinhandl works with the new PEER Kidney Care Initiative. It looks like a cool project. Here is some press from Nephrology News and Issues.
Noteworthy in Nephrology Social Media
The latest NephJC newsletter was just pushed out. For the second week there is a section that calls out what is new or noteworthy in the nephrology social media sphere.
This week's letter calls out Nikhil Shah's new nephrology blog, Nephrology Tweetbook and Fred Coe's kidney stone blog. We started identifying highlights last week. In the inaugural edition we identified the work being done by Tejas Desai and one of the latest nephrologist on Twitter, Dr. Ratna Samanta.
If you see or hear of anything that should be promoted on Noteworthy in Nephrology, drop us a tweet.
NephJC does RSS
RSS feed users
If you like subscribing to RSS feeds to get updates - we now make it easy to subscribe to our blog feed.
Click on this link and it will allow you to subscribe easily using your choice of reader.
If You Don't Know What RSS Stands for and Would Like to Know
RSS (Rich Site Summary - or really simple syndication as it is known more popularly) refers to a family of web formats that is used to publish information for frequently updated web sites, like blog posts, newspaper headlines and journals. Subscribing to a website RSS removes the need for the user to manually check the website for new content. In addition, by entering these 'feeds' into an aggregator or feed reader (Feedly is our current favourite - since Google decided to nix Google Reader), you will have all that content 'pushed' to you, notifying you of new posts. That's our secret to knowing the latest article published in Lancet. Look for this icon to find RSS feeds for your favourite website:
There are many advantages to using RSS feeds - you can get all the content you consume into one 'reader' i.e. news, medical journals, blogs etc. And, in addition, you can skim the headline, or the abstract - and decided if you want to click the link to read the full article in the original website. Enjoy!
New kid on the block: #RheumJC
The rheumatology crew that killed it during the Rituximab for ANCA vasculitis NephJC are striking out on there own with an ambitious plan for their own twitter journal club. They are kicking it off this coming Thursday with a GMT and EST at the exact same time as our NephJCs, 8GMT and 9EST. They are then doing a consolidation wrap up discussion the following day.
The first topic is one near and dear to all of our hearts, lupus nephritis. RCT of tacrolimus versus MMF for induction.
It would be great if some of our community could support the rheumatologists as they launch their journal club.
RheumJC home page | Press coverage | Twitter feed
More data on sodium and mortality
How long before we stop trumping data on sodium and blood pressure and start paying attention to the accumulating data on sodium and mortality. Latest data comes complements of the Health ABC Study in JAMA Internal Medicine:
“In our study, we observed no association between FFQ- determined dietary sodium intake and 10-year mortality or in- cident CVD and HF among older adults participating in the Health ABC Study. Compared with baseline sodium intake of 1500 to 2300 mg/d, no signal of benefit was observed with less than 1500 mg/d of sodium intake. ”
See this NephJC from August for on the subject of dietary sodium intake, blood pressure and mortality.
GMT Parathyroidectomy #NephJC
Parathyroidectomy #NephJC went great.
We had 30 people tweeting and 421 tweets. We were delighted to have study author, Areef Ishani join us:
Also making his first appearance at NephJC was John Asplin with some excellent input
Transcript and analytics
NSMC internship class announced
In late December, we announced the first Nephrology Social Media Internship. We had a great response with 16 applications. Honestly, I was hoping to get at least four applications. It was difficult sorting through all the capable applicants but we managed and are delighted to announce the initial crew:
See more at the NSMC Internship Home Page and keep up with what the interns are doing at the Intern's Blog.
Speechless...NephJC on the PubMed homepage.
Check it out quick while it's still there.
The Back2Basics: DCT Tweetchat summary post
The NephJC team was more than a bit nervous about undertaking a basic science, basic physiology paper for NephJC. We should stop being nervous and just trust in the NephJC community. Once again you guys defied adversity and did an amazing job at both the EST and the GMT Tweetchats.
Before the chat:
After the chat
The tweet of the night goes to Dr. Hoenig, who was participating in her first NephJC
As much as credit as we would like total for the success it was apparent to everyone in attendance that both chats hinged on the phenomenal contribution of Arohan "Call me Ro" Subramanya
Full transcript and analytics for part 1 (EST chat for the Western Hemisphere) here:
Storify here:
The analytics for part 2 (the GMT chat for Europe and Africa):
Storify is still pending...
Brilliant video on Open Access Publishing
My favorite part is where they point out that there is no evidence that the current publishing model is optimal. Let's hold our scientific publishing to the evidence standards that we use to evaluate science, and if the evidence is insufficient, it is time to experiment with alternatives.
Analytics from NephJC 18, the DCT, part 1
We had a spirited discussion last night with the American (North and South America) edition of #NephJC. Arohan Subramanya, study author, was a super star. He joined the chat and answered a ton of questions. Hopefully he can join the Euro/African edition today at 8 pm GMT (3 pm EST).
The analytics were impressive, especially since the chat was almost entirely nephrologists.
Today is the deadline for applications to the NSMC Internship
If you want to be an intern in the inaugural class apply now!
Invited editorial: Why physiology?
I became a nephrologist because of Burton Rose. More specifically, because of the “yellow book” – the fourth edition of Clinical Physiology of Acid-Base and Electrolyte Disorders. As I look at my dog-eared and over-used copy I see it was published 1994 and last updated in 2001.
From this book, I learned that renal physiology is relavant to most hospitalized patients and is relevant to all patients in the ICU. Every hospitalized patient is either receiving IV fluids or diuretics. Electrolytes are checked daily, and most have at least a single abnormality. Edema from heart and liver failure are problems directly related to abnormal renal physiology. Understanding fluids and electrolytes is a foundational concept of hospital care, and understanding fluids and electrolytes is rooted in renal physiology.
From this book, I learned that the the kidney is amazing (and smart). One hundred eighty liters of plasma are filtered every day! The counter-current exchange can concentrate urine to 1400 mOsm/L from a serum a osmolality of 290! The concept of Tm is able to explain the apparently diverse findings in diabetes (glucosuria), proximal RTAs and Fanconi syndrome!
From this book, I learned renal physiology. And I understood how renal physiology related to the entirety of clinical medicine. And that was the most exciting part. Fluid and electrolyte problems and their management could be solved by applying the basic principles. There was logic to it – and I knew what the logic was. I became a nephrologists because it was the only subject that was explained really well and I understood it. Strangely, today a source of the lack in interest in nephrology is because it is “too hard”. Are we suffering from a post Burton Rose funk?
As the years accumulate since the last update to Rose's masterpiece, who is explaining renal physiology now? Who is demonstrating the intricate genius of the nephron? Who is making it clear that if you are interested in hospital medicine and critical care, that you are actually interested in (and need to know) renal physiology? Lots of residents are becoming hospitalists – is it because hospital medicine is so wonderfully accessable and understandable with the advent of UpToDate, another Burton Rose creation?
The editors of CJASN understand the situation perfectly. Understanding renal physiology is the essence of being a nephrologist. At this stage in my career, it is hard to imagine that I will be reading another textbook – thus, the CJASN series is filling an extremely important need for a comprehensive and comprehendible renal physiology resource. Hopefully, it can help inspire future nephrologists as well.
Sarah Faubel is a Professor of Medicine at the University of Colorado and chair of the ASN AKI advisory group. Her Twitter handle is Doc_Faubel.