Skip to main content

Updates in Nephrology for the Hospitalist

  • Chapter
  • First Online:
Clinical Approaches to Hospital Medicine

Abstract

This chapter gives a broad overview of nephrology as it affects hospitalists while also hoping to answer a few of the essential questions hospitalists may ask their nephrology colleagues. Evaluation and treatment of both acute and chronic kidney disease is constantly evolving as the small but tight-knit community of hospital-nephrologists continue to collect, review, and research data. The majority of the chapter will be focused on discussing a few new updates in the field of nephrology and how these updates could potentially change hospital care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zhou Y, Yang J. Chronic kidney disease: overview. In: Chronic kidney disease: diagnosis and treatment. Singapore: Springer Singapore; 2020. p. 3–12. https://doi.org/10.1007/978-981-32-9131-7_1.

    Chapter  Google Scholar 

  2. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Tamura MK, Feldman HI, Rocco MV, Berns JS. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713–35. https://doi.org/10.1053/j.ajkd.2014.01.416.

    Article  PubMed  Google Scholar 

  3. Calderon K, Jhaveri K. Innovative teaching tools in medicine. In: 3rd international conference on education and new learning technologies (EDULEARN), Barcelona, SPAIN, Jul 04–06 2011. EDULEARN Proceedings; 2011. p. 1093–4.

    Google Scholar 

  4. Jhaveri KD, Sparks MA, Shah HH, Khan S, Chawla A, Desai T, Iglesia E, Ferris M, Parker MG, Kohan DE. Why not nephrology? A survey of US internal medicine subspecialty fellows. Am J Kidney Dis. 2013;61(4):540–6. https://doi.org/10.1053/j.ajkd.2012.10.025.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pavkov ME, Harding JL, & Burrows NR. Trends in Hospitalizations for Acute Kidney Injury - United States, 2000–2014. MMWR. 2018;67(10);289–93. https://doi.org/10.15585/mmwr.mm6710a2.

  6. Sawhney S, Fraser SD. Epidemiology of AKI: utilizing large databases to determine the burden of AKI. Adv Chronic Kidney Dis. 2017;24(4):194–204. https://doi.org/10.1053/j.ackd.2017.05.001.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mohamed MMB, Lukitsch I, Torres-Ortiz AE, Walker JB, Varghese V, Hernandez-Arroyo CF, Alqudsi M, LeDoux JR, Velez JCQ. Acute kidney injury associated with coronavirus disease 2019 in urban New Orleans. Kidney360. 2020;1(7):614. https://doi.org/10.34067/KID.0002652020.

    Article  Google Scholar 

  8. Acosta-Ochoa I, Bustamante-Munguira J, Mendiluce-Herrero A, Bustamante-Bustamante J, Coca-Rojo A. Impact on outcomes across KDIGO-2012 AKI criteria according to baseline renal function. J Clin Med. 2019;8(9). https://doi.org/10.3390/jcm8091323.

  9. Liu KD, Goldstein SL, Vijayan A, Parikh CR, Kashani K, Okusa MD, Agarwal A, Cerda J, Amer AKINI. AKI!Now initiative: recommendations for awareness, recognition, and management of AKI. Clin J Am Soc Nephrol. 2020;15(12):1838–47. https://doi.org/10.2215/cjn.15611219.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Macedo E, Bihorac A, Siew ED, Palevsky PM, Kellum JA, Ronco C, Mehta RL, Rosner MH, Haase M, Kashani KB, Barreto EF. Quality of care after AKI development in the hospital: consensus from the 22nd Acute Disease Quality Initiative (ADQI) conference. Eur J Intern Med. 2020;80:45–53. https://doi.org/10.1016/j.ejim.2020.04.056.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yassin AR, Sherif HM, Mousa AY, Esmat A. Comparison between fractional excretion of sodium and fractional excretion of urea in differentiating prerenal from renal azotemia in circulatory shock. Egyp. J Crit Care Med. 2013;1(2):69–77. https://doi.org/10.1016/j.ejccm.2013.05.001.

    Article  Google Scholar 

  12. Bagshaw SM, Bellomo R. Urine abnormalities in acute kidney injury and sepsis. Cardiorenal Syndr Crit Care. 2010;165:274–83. https://doi.org/10.1159/000313767.

    Article  Google Scholar 

  13. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet (London, England). 2012;380(9843):756–66. https://doi.org/10.1016/s0140-6736(11)61454-2.

    Article  Google Scholar 

  14. Kanbay M, Kasapoglu B, Perazella MA. Acute tubular necrosis and pre-renal acute kidney injury: utility of urine microscopy in their evaluation- a systematic review. Int Urol Nephrol. 2010;42(2):425–33. https://doi.org/10.1007/s11255-009-9673-3.

    Article  PubMed  Google Scholar 

  15. Chaumont M, Pourcelet A, van Nuffelen M, Racape J, Leeman M, Hougardy JM. Acute kidney injury in elderly patients with chronic kidney disease: do angiotensin-converting enzyme inhibitors carry a risk? J Clin Hypertens. 2016;18(6):514–21. https://doi.org/10.1111/jch.12795.

    Article  CAS  Google Scholar 

  16. Ronco C, Reis T, Husain-Syed F. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med. 2020;8(7):738–42. https://doi.org/10.1016/s2213-2600(20)30229-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Zheng XZ, Zhao YL, Yang L. Acute kidney injury in COVID-19: the Chinese experience. Semin Nephrol. 2020;40(5):430–42. https://doi.org/10.1016/j.semnephrol.2020.09.001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Velez JCQ, Caza T, Larsen CP. COVAN is the new HIVAN: the re-emergence of collapsing glomerulopathy with COVID-19. Nat Rev Nephrol. 2020;16(10):565–7. https://doi.org/10.1038/s41581-020-0332-3.

    Article  CAS  PubMed  Google Scholar 

  19. Giordano M, Ciarambino T, Castellino P, Malatino L, Di Somma S, Biolo G, Paolisso G, Adinolfi LE. Diseases associated with electrolyte imbalance in the ED: age-related differences. Am J Emerg Med. 2016;34(10):1923–6. https://doi.org/10.1016/j.ajem.2016.05.056.

    Article  PubMed  Google Scholar 

  20. Betts KA, Woolley JM, Mu F, McDonald E, Tang WX, Wu EQ. The prevalence of hyperkalemia in the United States. Curr Med Res Opin. 2018;34(6):971–8. https://doi.org/10.1080/03007995.2018.1433141.

    Article  PubMed  Google Scholar 

  21. Mushiyakh Y, Dangaria H, Qavi S, Ali N, Pannone J, Tompkins D. Treatment and pathogenesis of acute hyperkalemia. J Community Hosp Intern Med Perspect. 2012;1(4). https://doi.org/10.3402/jchimp.v1i4.7372.

  22. Mann JFE. Cardiovascular risk in patients with mild renal insufficiency: implications for the use of ACE inhibitors. Presse Med. 2005;34(18):1303–8. https://doi.org/10.1016/s0755-4982(05)84178-8.

    Article  CAS  PubMed  Google Scholar 

  23. Epstein M, Pitt B. Recent advances in pharmacological treatments of hyperkalemia: focus on patiromer. Expert Opin Pharmacother. 2016;17(10):1435–48. https://doi.org/10.1080/14656566.2016.1190333.

    Article  CAS  PubMed  Google Scholar 

  24. Hoskote SS, Joshi Sr Fau - Ghosh AK, Ghosh AK. Disorders of potassium homeostasis: pathophysiology and management. (0004-5772 (Print)).

    Google Scholar 

  25. Collins AJ, Pitt B, Reaven N, Funk S, McGaughey K, Wilson D, Bushinsky DA. Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and/or diabetes. Am J Nephrol. 2017;46(3):213–21. https://doi.org/10.1159/000479802.

    Article  CAS  PubMed  Google Scholar 

  26. Sterns RH, Rojas M, Bernstein P, Chennupati S. Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective? J Am Soc Nephrol. 2010;21(5):733–5. https://doi.org/10.1681/asn.2010010079.

    Article  CAS  PubMed  Google Scholar 

  27. Flinn RB, Merrill JP, Welzant WR. Treatment of the oliguric patient with a new sodium-exchange resin and sorbitol; a preliminary report. (0028-4793 (Print)).

    Google Scholar 

  28. Noel JA, Bota SE, Petrcich W, Garg AX, Carrero JJ, Harel Z, Tangri N, Clark EG, Komenda P, Sood MM. Risk of hospitalization for serious adverse gastrointestinal events associated with sodium polystyrene sulfonate use in patients of advanced age. (2168-6114 (Electronic)).

    Google Scholar 

  29. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, Hill CL, McCague K, Mi X, Patterson JH, Spertus JA, Thomas L, Williams FB, Hernandez AF, Fonarow GC. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. (1558-3597 (Electronic)).

    Google Scholar 

  30. Picard K, Griffiths M, Mager DR, Richard C. Handouts for low-potassium diets disproportionately restrict fruits and vegetables. J Ren Nutr. 2021;31(2):210–4. https://doi.org/10.1053/j.jrn.2020.07.001.

    Article  CAS  PubMed  Google Scholar 

  31. Pitt B, Bakris GL, Bushinsky DA, Garza D, Mayo MR, Stasiv Y, Christ-Schmidt H, Berman L, Weir MR. Effect of patiromer on reducing serum potassium and preventing recurrent hyperkalemia in patients with heart failure and chronic kidney disease on RAAS inhibitors. Eur J Heart Fail. 2015;17(10):1057–65. https://doi.org/10.1002/ejhf.402.

    Article  CAS  PubMed  Google Scholar 

  32. Ferreira JP, Abreu P, McMurray JJV, van Veldhuisen DJ, Swedberg K, Pocock SJ, Vincent J, Lins K, Rossignol P, Pitt B, Zannad F. Renal function stratified dose comparisons of eplerenone versus placebo in the EMPHASIS-HF trial. Eur J Heart Fail. 2019;21(3):345–51. https://doi.org/10.1002/ejhf.1400.

    Article  CAS  PubMed  Google Scholar 

  33. Rossignol P, Dobre D, McMurray JJ, Swedberg K, Krum H, van Veldhuisen DJ, Shi H, Messig M, Vincent J, Girerd N, Bakris G, Pitt B, Zannad F. Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Circ Heart Fail. 2014;7(1):51–8. https://doi.org/10.1161/circheartfailure.113.000792.

    Article  CAS  PubMed  Google Scholar 

  34. Packham DK, Kosiborod M. Pharmacodynamics and pharmacokinetics of sodium zirconium cyclosilicate ZS-9 in the treatment of hyperkalemia. Expert Opin Drug Metab Toxicol. 2016;12(5):567–73. https://doi.org/10.1517/17425255.2016.1164691.

    Article  CAS  PubMed  Google Scholar 

  35. Lepage L, Desforges K, Lafrance JP. New drugs to prevent and treat hyperkalemia. Curr Opin Nephrol Hypertens. 2016;25(6):524–8. https://doi.org/10.1097/mnh.0000000000000272.

    Article  CAS  PubMed  Google Scholar 

  36. Worthley LIG, Guerin M, Pain RW. For calculating osmolality, the simplest formula is the best. Anaesth Intensive Care. 1987;15(2):199–202. https://doi.org/10.1177/0310057x8701500214.

    Article  CAS  PubMed  Google Scholar 

  37. Liamis G, Filippatos TD, Liontos A, Elisaf MS. Serum osmolal gap in clinical practice: usefulness and limitations. Postgrad Med. 2017;129(4):456–9. https://doi.org/10.1080/00325481.2017.1308210.

    Article  PubMed  Google Scholar 

  38. Kar E, Kocaturk E, Kiraz ZK, Demiryurek B, Alatas IO. Comparison of measured and calculated osmolality levels. Clin Exp Nephrol. 2020;24(5):444–9. https://doi.org/10.1007/s10157-020-01848-1.

    Article  CAS  PubMed  Google Scholar 

  39. Feehally J, Khosravi M. Effects of acute and chronic hypohydration on kidney health and function. Nutr Rev. 2015;73:110–9. https://doi.org/10.1093/nutrit/nuv046.

    Article  PubMed  Google Scholar 

  40. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, Thompson CJ. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10):S5–S41. https://doi.org/10.1016/j.amjmed.2013.07.006.

    Article  Google Scholar 

  41. Torino C, Gargani L, Sicari R, Letachowicz K, Ekart R, Fliser D, Covic A, Siamopoulos K, Stavroulopoulos A, Massy ZA, Fiaccadori E, Caiazza A, Bachelet T, Slotki I, Martinez-Castelao A, Coudert-Krier M-J, Rossignol P, Gueler F, Hannedouche T, Panichi V, Wiecek A, Pontoriero G, Sarafidis P, Klinger M, Hojs R, Seiler-Mussler S, Lizzi F, Siriopol D, Balafa O, Shavit L, Tripepi R, Mallamaci F, Tripepi G, Picano E, London GM, Zoccali C. The agreement between auscultation and lung ultrasound in hemodialysis patients: the LUST study. Clin J Am Soc Nephrol. 2016;11(11):2005–11. https://doi.org/10.2215/CJN.03890416.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Koratala A, Ronco C, Kazory A. Need for objective assessment of volume status in critically ill patients with COVID-19: the tri-POCUS approach. Cardiorenal Med. 2020;10(4):209–16. https://doi.org/10.1159/000508544.

    Article  CAS  PubMed  Google Scholar 

  43. Ekinci C, Karabork M, Siriopol D, Dincer N, Covic A, Kanbay M. Effects of volume overload and current techniques for the assessment of fluid status in patients with renal disease. Blood Purif. 2018;46(1):34–47. https://doi.org/10.1159/000487702.

    Article  PubMed  Google Scholar 

  44. Ugras S. Evaluating of altered hydration status on effectiveness of body composition analysis using bioelectric impedance analysis. Libyan J Med. 2020;15(1):1741904. https://doi.org/10.1080/19932820.2020.1741904.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Afkarian M, Zelnick LR, Hall YN, Heagerty PJ, Tuttle K, Weiss NS, de Boer IH. Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014. JAMA. 2016;316(6):602–10. https://doi.org/10.1001/jama.2016.10924.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nat Rev Nephrol. 2016;12(2):73–81. https://doi.org/10.1038/nrneph.2015.173.

    Article  CAS  PubMed  Google Scholar 

  47. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032–45. https://doi.org/10.2215/cjn.11491116.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Tomita I, Kume S, Sugahara S, Osawa N, Yamahara K, Yasuda-Yamahara M, Takeda N, Chin-Kanasaki M, Kaneko T, Mayoux E, Mark M, Yanagita M, Ogita H, Araki SI, Maegawa H. SGLT2 inhibition mediates protection from diabetic kidney disease by promoting ketone body-induced mTORC1 inhibition. Cell Metab. 2020;32(3):404–419.e406. https://doi.org/10.1016/j.cmet.2020.06.020.

    Article  CAS  PubMed  Google Scholar 

  49. Poulsen SB, Fenton RA, Rieg T. Sodium-glucose cotransport. Curr Opin Nephrol Hypertens. 2015;24(5):463–9. https://doi.org/10.1097/mnh.0000000000000152.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Hsia DS, Grove O, Cefalu WT. An update on sodium-glucose co-transporter-2 inhibitors for the treatment of diabetes mellitus. Curr Opin Endocrinol Diabetes Obes. 2017;24(1):73–9. https://doi.org/10.1097/MED.0000000000000311.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Vallon V, Thomson SC. Targeting renal glucose reabsorption to treat hyperglycaemia: the pleiotropic effects of SGLT2 inhibition. (1432-0428 (Electronic)).

    Google Scholar 

  52. Cefalu WT, Stenlöf K, Leiter LA, Wilding JP, Blonde L, Polidori D, Xie J, Sullivan D, Usiskin K, Canovatchel W, Meininger G. Effects of canagliflozin on body weight and relationship to HbA1c and blood pressure changes in patients with type 2 diabetes. (1432–0428 (Electronic)).

    Google Scholar 

  53. Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, Edwards R, Agarwal R, Bakris G, Bull S, Cannon CP, Capuano G, Chu P-L, de Zeeuw D, Greene T, Levin A, Pollock C, Wheeler DC, Yavin Y, Zhang H, Zinman B, Meininger G, Brenner BM, Mahaffey KW. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295–306. https://doi.org/10.1056/NEJMoa1811744.

    Article  CAS  Google Scholar 

  54. Neal B, Perkovic V, Mahaffey KW, Fulcher G, Erondu N, Desai M, Shaw W, Law G, Walton MK, Rosenthal N, de Zeeuw D, Matthews DR, Grp CPC. Optimizing the analysis strategy for the CANVAS program: a prespecified plan for the integrated analyses of the CANVAS and CANVAS-R trials. Diabetes Obes Metab. 2017;19(7):926–35. https://doi.org/10.1111/dom.12924.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Garofalo C, Borrelli S, Liberti ME, Andreucci M, Conte G, Minutolo R, Provenzano M, De Nicola L. SGLT2 inhibitors: nephroprotective efficacy and side effects. Medicina (Kaunas). 2019;55(6). https://doi.org/10.3390/medicina55060268.

  56. Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium-glucose cotransporter 2 inhibition. Diabetes Care. 2015;38(9):1687–93. https://doi.org/10.2337/dc15-0843.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Braden GL, Chapman A, Ellison DH, Gadegbeku CA, Gurley SB, Igarashi P, Kelepouris E, Moxey-Mims MM, Okusa MD, Plumb TJ, Quaggin SE, Salant DJ, Segal MS, Shankland SJ, Somlo S. Advancing nephrology division leaders advise ASN. Clin J Am Soc Nephrol. 2021;16(2):319–27. https://doi.org/10.2215/CJN.01550220.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Juan Carlos Q. Velez .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Velez, J.C.Q. et al. (2022). Updates in Nephrology for the Hospitalist. In: Conrad, K. (eds) Clinical Approaches to Hospital Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-95164-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-95164-1_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95163-4

  • Online ISBN: 978-3-030-95164-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics