Thursday, November 21, 2013

Monday, November 18, 2013

Thursday, November 14, 2013

VA NEPHRON-D study

Another nail in the coffin for combination ACE/ARB in diabetic nephropathy!
http://www.nejm.org/doi/full/10.1056/NEJMoa1303154?query=TOC

Also see Kiran/Pradeep's posts on this article on Nov 10th.
Regarding Pradeep's question: might there still be a role for combined ACE/ARB in non-diabetics with CKD and proteinuria?  Obviously this study was in diabetics and will not directly inform ACE+ARB use in non-diabetics. But its impressive that their findings generally confirm those in ONTARGET, suggesting adverse outcomes (renal failure, hyperkalemia) with combination therapy.  ONTARGET included both diabetics and non-diabetics, and subgroup analysis suggested the adverse outcomes were not affected by the presence/absence of diabetes.

So I will continue to consider combined ACE/ARB only in very exceptional circumstances (perhaps multi-drug resistant hypertension and/or severe refractory proteinuria), and only with diligent laboratory monitoring.


Sunday, November 10, 2013

Demystifying kidney disease for the average Joe!: Can certain herbal medications treat chronic kidne...

Demystifying kidney disease for the average Joe!: Can certain herbal medications treat chronic kidne...: I set off to try and answer this question after one of my patients whom I saw at my Bradenton clinic brought along an article that claimed ...

Nice one on "NETTLE". I had one recently who asked me about Nettle.

Precious Bodily Fluids: Tolvaptan, ADPKD, and lack of vision at the FDA

Precious Bodily Fluids: Tolvaptan, ADPKD, and lack of vision at the FDA: About a year ago the ASN Kidney Week hosted the most exciting Late Breaking Trial Session I have attended. The session included the first pu...

Abatacept in B7-1–Positive Proteinuric Kidney Disease — NEJM

Abatacept in B7-1–Positive Proteinuric Kidney Disease — NEJM

A New Era of Podocyte-Targeted Therapy for Proteinuric Kidney Disease — NEJM

A New Era of Podocyte-Targeted Therapy for Proteinuric Kidney Disease — NEJM

Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy — NEJM

Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy — NEJM

APOL1 Risk Variants, Race, and Progression of Chronic Kidney Disease — NEJM

APOL1 Risk Variants, Race, and Progression of Chronic Kidney Disease — NEJM

New Therapies for Diabetic Kidney Disease — NEJM

New Therapies for Diabetic Kidney Disease — NEJM

The End of Dual Therapy with Renin–Angiotensin–Aldosterone System Blockade? — NEJM

The End of Dual Therapy with Renin–Angiotensin–Aldosterone System Blockade? — NEJM