Did you miss these recent slide/audio lectures?
Therapeutic Issues in Crescentic Glomerulonephritis and Vasculitis
Luis F. Flores-Suarez, MD, PhD, Marten Segelmark, MD, and Ulrich Specks, MD
(ASN Renal Week Clinical Nephrology Conference, November, 2008.)
Flores-Suarez: How can we subgroup the vasculitides based on presentation? What are the complications associated with cyclophosphamide? For early, generalized disease, what did NORAM show re methotrexate? The Cleveland Clinic study? What did CYCLOPS show regarding IV cyclophosphamide? What did MEPEX show regarding use of plasma exchange in severe disease? Does azathioprine or MMF work? What about rituximab? What are the early results of the RITUXVAS study? What are the prognostic factors of ANCA-vasculitis? Biomarkers? Segelmark: How do we approach the patient with vasculitis who has had multiple relapses? What are the different types of therapy resistance? What is standard initial therapy? What are the choices to treat relapses, and what do studies show regarding their efficacy? Specks: How do we approach the pulmonary and other extrarenal manifestations of vasculitis? What are the manifestations of vasculitis in the alveoli, tracheobronchial tree, and nasal cartilages? What is the differential diagnosis and how do we decide if it is vasculitis or not? How do treatment options differ from those in patients with primarily renal disease?
Impact of Bundled Payments on Care for ESRD Patients
Ray Hakim, MD; John Moran, MD; Allen Nissenson, MD; Rajiv Saran, MD; and Wolfgang Winkelmayer, MD (Moderator: Jonathan Himmelfarb, MD)
(ASN Renal Week Official Symposium, 2009.)
Panel Discussions (1) What is MIPPA, and how did CMS propose to implement it with the proposed bundled reimbursement system? (2) What are the controversial aspects of bundling? (3) How might bundling impact on patient care? (4) How might bundling limit physicians' choices? (5) What does the nephrology community have to learn from bundling? How can we intercede to make sure that bundling is fairly applied? (6) Audience questions.
New Frontiers in Chronic Kidney Disease-Mineral Bone Disorders
Isidro B. Salusky, MD; Orlando M. Gutierrez, MD, MMSc; and David A. Bushinsky, MD. (Moderator: Myles S. Wolf, MD)
(ASN Renal Week Official Symposium, 2009.)
Salusky: As CKD progresses, 1,25D goes down very early. Why? What are the 2 ways that FGF23 is involved? What organ makes FGF23, and how is FGF23 involved in maintaining architecture of bone? Gutierrez: How is FGF23 related to outcomes in CKD and in incident dialysis patients? How is FGF23 related to left ventricular hypertrophy? Does FGF23 associated with CKD progression? Bushinsky: How is coronary calcification related to mortality in CKD? How might calcium balance in CKD affect calcification? What should be the goal in terms of net calcium balance in CKD? What are the factors that affect calcium balance in CKD patients, and how are they different from nonuremic healhies? What's the role of the dialysate calcium concentration? How is gastrointestinal absorption of calcium affected by vitamin D? What is the dietary calcium intake associated with a zero calcium balance when dialysate Ca is 2.5 mEq/L, with and without vitamin D?
Hepatorenal Syndrome
Robert W. Schrier, MD, Hani M. Wadei, MD, and Andrew Davenport, MD
(ASN Renal Week Official Symposium, 2009.)
Schrier: What is the pathophysiology of hepatorenal syndrome? What components of the underfilling and systemic arterial vasodilatation hypotheses are important clinically? What is the role of distal sodium delivery? How is hyponatremia important as a marker of outcome in cirrhosis? What happens with aldosterone antagonism? Mannitol plus atrial natriuretic peptide? What is the evidence that nitric oxide is important? Wadei: Management options include vasoconstrictors, TIPS, a combination of these, renal replacement therapy, and transplantation. When is each of these indicated?
What vasoconstrictors should one use? What do studies with terlipressin show? Is albumin infusion independently useful? What are the predictors of reversal of hepatorenal syndrome with treatment? Davenport: How do we characterize AKI (acute kidney insufficiency) in patients with liver failure? What are the determinants of recovery? What is the evidence regarding harmful effects of intradialytic hypotension? How can we prevent this using thermal effects, midodrine, and other maneuvers? What to kidney biopsy studies show in patients with AKI and liver failure? How might this guide us in therapy? When should combined liver-kidney transplant be considered?
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