Podcasts about pediatric nephrology

The FiltrateJoel TopfSwapnil HiremathAC GomezSopia AmbrusoNayan AroraSpecial Guests Michelle Rheault, Director, Division of Pediatric Nephrology, Professor of MedicineTiffany Caza, Nephropathologist, Scientist and self-described Freely Filtered fan girlEditing bySimon Topf and Sophia AmbrusoShow Notes10. Healthcare Cyberattacks9. ApoE in C3 glomerulonephropathy8. Workforce woes in Adult and Pediatric Nephrology7. Hyponatremia correction meta-analysis6. Microvascular inflammation increases risk of graft loss - in all of its forms5. Xenotransplantation4. KDIGO CKD Guidelines3. Hypertension control trials (ESPRIT, BPROAD)2. The Renaissance of IgAN: IgAN treatment trials1. FLOW: GLP-1 RAs in CKD

Carlton Bates, MD, chief of the Division of Pediatric Nephrology, has been caring for children with pediatric kidney disease for many years, but he often finds another organ on his mind: the bladder and the role it plays in the health of a kidney. Dr. Bates discusses his well-recognized research program in Pittsburgh focused on the genetic regulation of kidney and bladder development.

In this episode, we speak with Dr. Mary Leonard, MD who is the Arline and Pete Harman Professor and Chair of the Department of Pediatrics at Stanford University School of Medicine, as well as the Adalyn Jay Physician in Chief at Lucile Packard Children's Hospital Stanford. Our conversation delves into Dr. Leonard's remarkable journey in medicine, her ascent to the distinguished roles of professor and department chair at Stanford, and her profound insights into pediatric kidney disease. We will explore the manifestations of kidney conditions in pediatric patients, her research endeavors in this domain, and the promising advancements in pediatric nephrology care. Read Transcript CME Information: https://stanford.cloud-cme.com/medcastepisode82 Claim CE and MOC: https://stanford.cloud-cme.com/Form.aspx?FormID=1873  

Given the lack of a transplant-specific curriculum within the ACGME guidelines, the Transplant Interest Group (under the American Society of Pediatric Nephrology) has worked to create a transplant specific curriculum.

Dr. Arthur M. Lee provides an overview of the results of his study, "Circulating Metabolomic Associations with Neurocognitive Outcomes in Pediatric CKD," on behalf of his colleagues.

The Filtrate:Joel TopfSwapnil HiremathSophia AmbrusoAC GomezJosh WaitzmanJennie LinNayan AroraThe CurbsidersMatt F. Watto (@DoctorWatto)Paul Nelson Williams, America's primary care physician (@PaulNWilliamz)With Special Guest:JD Foster (@KidneyVet)Sayed Tabatabai (@TheRealDoctorT) Nephrologist in Austin and the author of These Vital SignsMichelle Rheault (@rheault_m) Chief of Pediatric Nephrology at the University of Minnesota and lead author of the DUPLEX TrialEditor:Joel TopfShow Notes:Lily toxicity in the cat (PubMed)Surgeons perform kidney transplants in cats amid rising demand for advanced pet care (ABC News)Treatment of ibuprofen toxicity with serial charcoal hemoperfusion and hemodialysis in a dog (PubMed)Nephrology in Veterinary Medicine (Kidney 360)Star Wars Society of San Antonio (FaceBook)These Vital Signs (Amazon)Dr Tabatabai read a short story called The Handholder, here is the original tweet thread for that story (ThreadReader)The pearl not the patient (PubMed)Late Braking and High Impact Clinical Trial press releaseMENTOR, Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy, was in 2019 not 2017 (NEJM)KALM-1, A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus, was in 2019 not 2017 (NEJM)Sophie's number one pick: Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial (Lancet)Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058).Clinical Trial Considerations in Developing Treatments for Early Stages of Common, Chronic Kidney Diseases: A Scientific Workshop Cosponsored by the National Kidney Foundation and the US Food and Drug Administration (AJKD)AC Gomez's Pick: MDR-101-MLK Update: Operational Immune Tolerance Achieved in Living Related HLA-Matched Kidney Transplant Recipients (ASN-Online.org) Josh's Pick: A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy (NEJM)Nayan's Pick: The EnAKT LKD Cluster Randomized Clinical Trial (JAMA Internal Medicine) The Freely Filtered simultaneous release (NephJC)Freely Filtered is now a verb. Swap's Pick: Strategies for the Management of Atrial Fibrillation in PatiEnts Receiving Dialysis (SAFE-D) (ASN-Online.org)Joel's Pick: AYAME Study: Randomized, Double-Blind, Placebo-Controlled Phase 3 Study of Bardoxolone Methyl in Diabetic Kidney Disease (DKD) Patients (ASN-Online.org)Reata is a no-show to the 2012 ASN Kidney Week (PBFluids)Michelle's Pick: Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis. The DUPLEX Study (NEJM)DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed)

Dr. Nick Larkins discusses the findings of his study, "Timing of Kidney Replacement Therapy among Children and Young Adults," on behalf of his colleagues.

Nocturnal enuresis is a common problem for pediatric patients that can be quite distressing for children as well as their parents. In this episode join Madeline Snipes, a medical student at the Medical College of Georgia as she discusses nocturnal enuresis with Chief of Pediatric Urology at the Children's Hospital of Georgia, Dr. Bradley Morganstern, and Associate Professor of Pediatrics, Dr. Susan Goldberg, on an overview of nocturnal enuresis. Specifically, they will review:  • The definition of nocturnal enuresis and its basic epidemiology.   • The potential causes of nocturnal enuresis.   • The appropriate workup for a pediatric patient with nocturnal enuresis.   • When referral to a pediatric urologist is indicated.   • The various treatment options for a pediatric patient with nocturnal enuresis.   • And finally the potential sequelae that may result from untreated nocturnal enuresis.  Special thanks to Dr. Jordan Gitlin, pediatric urologist at NYU's Winthrop Hospital, and Dr. Shreeti Kapoor, general pediatrician and associate professor of pediatric medicine at the Medical College of Georgia at Augusta University.  FREE CME Credit (requires free sign-up):  Link coming soon! References: 1. Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis—an updated standardization document from the International Children's Continence Society. Journal of Pediatric Urology. 2020;16(1):10-19. doi:10.1016/j.jpurol.2019.12.020  2. Järvelin MR, Vikeväinen-Tervonen L, Moilanen I, Huttunen NP. Enuresis in seven-year-old children. Acta paediatrica Scandinavica. 1988;77(1):148-153. doi:10.1111/j.1651-2227.1988.tb10614.  3. de Sena Oliveira AC, Athanasio B da S, Mrad FC de C, et al. Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis. Pediatric Nephrology. 2021;36(11):3547-3559. doi:10.1007/s00467-021-05083-y  4. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuretis. Arch Dis Child. 1974;49(4):259-263. doi:10.1136/adc.49.4.259  5. von Gontard A, Mauer-Mucke K, Plück J, Berner W, Lehmkuhl G. Clinical behavioral problems in day- and night-wetting children. Pediatr Nephrol. 1999;13(8):662-667. doi:10.1007/s004670050677  6. Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360(14):1429-1436. doi:10.1056/NEJMcp0808009  7. Yeung CK, Sreedhar B, Sihoe JD, Sit FK, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU Int. 2006;97(5):1069-1073. doi:10.1111/j.1464-410X.2006.06074.x  8. Sá CA, Martins de Souza SA, Villela MCBVA, et al. Psychological Intervention with Parents Improves Treatment Results and Reduces Punishment in Children with Enuresis: A Randomized Clinical Trial. J Urol. 2021;205(2):570-576. doi:10.1097/JU.0000000000001351  9. Jackson EC. Nocturnal enuresis: giving the child a "lift". J Pediatr. 2009;154(5):636-637. doi:10.1016/j.jpeds.2009.01.041  10. Plaire JC, Pope JC 4th, Kropp BP, et al. Management of ectopic ureters: experience with the upper tract approach. J Urol. 1997;158(3 Pt 2):1245-1247.  11. Alnatour IM, Alnashrati T. Nocturnal Enuresis. Middle East Journal of Family Medicine. 2022;20(7):127-131. doi:10.5742/MEWFM.2022.9525106  12. van Summeren JJGT, Holtman GA, van Ommeren SC, Kollen BJ, Dekker JH, Berger MY. Bladder Symptoms in Children With Functional Constipation: A Systematic Review. J Pediatr Gastroenterol Nutr. 2018;67(5):552-560. doi:10.1097/MPG.0000000000002138  13. Brownrigg N, Braga LH, Rickard M, et al. The impact of a bladder training video versus standard urotherapy on quality of life of children with bladder and bowel dysfunction: A randomized controlled trial. J Pediatr Urol. 2017;13(4):374.e1-374.e8. doi:10.1016/j.jpurol.2017.06.005 

Dr. Katherine Twombley, Chief of Pediatric Nephrology at the Medical University of South Carolina talks about the culture ofputting patients first, and about her work in nephrology.    Interview Copy:   Dr. Katherine Twombley, says the culture at the Medical University of South Carolina removes barriers in the interest of putting patients first, and empowers medical teams to do the right thing because it's the right things to do.    As a Professor of Pediatrics, Chief of Pediatric Nephrology, Medical Director of the Pediatric Kidney Transplant Program, and Program Director of the Pediatric Nephrology Fellowship at MUSC, she knows how important it is to get treatment to patients.    She tells us that by removing administrative hurdles, providers at MUSC can focus on treating the patient right away, rather than delaying much-needed care due to red-tape.   Dr. Twombley shares an example of getting a new therapy approved for a patient within days, whereas it may take months in other systems. She says this is a game-changer for patients, and gives them hope.  provide hope for patients and families.   Check out the full interview with Dr. Twombley to hear more about putting the patient first, and some of the life-changing treatments she and her team offer.    You can also listen to the interview in podcast form:   Apple podcast link:  https://podcasts.apple.com/us/podcast/speaking-of/id1549592446     I Heart podcast link: https://www.iheart.com/podcast/269-speaking-of-76708275/#     Spotify podcast link: https://open.spotify.com/show/1g2LUGr0SzxbBmSHB3FHyL?si=PNO79sBOReGXQJu_CrsJEg   Learn more about the Medical Univ. of South Carolina: https://muschealth.org    Learn more about the MUSC Children's Hospital: https://musckids.org    Topical time codes: 00:57 - Treating the patient, not the disease 1:53 - Culture at MUSC 3:06 - Removing barriers and admin hurdles 6:23 - Doing things because it's the right thing to do 8:10 -  Providing hope to patients 9:03 - LDL-Aphaeresis 12:28 - Patient referrals 14:11 - Nephrotic syndrome trials, precision medicine 16:17 - Changing lives through precision medicine   __________________________ Thanks to the following organizations for supporting the Making Healthcare Work for You mission.   Informed Consulting works with insurance carriers, digital health companies, insurtech organizations, and venture capital firms to drive distribution solutions in the employee benefits ecosystem. They help companies reach revenue potential, confidently navigate a complex ecosystem, and position benefit ecosystem innovations for more efficient growth.   Visit https://www.informed.llc to learn more.   UpStream is the fastest-growing primary healthcare solution provider in the US.    UpStream underwrites and supports the delivery of value-based care for older patients and people living with chronic conditions. By working in partnership with healthcare practices and clinics UpStream offers a comprehensive risk-free solution for physicians that finances, delivers and sustains better outcomes for everyone. Visit https://www.upstream.care  to learn more. __________________________

While FSGS was once thought to be a single disease entity, it is now understood to be a pattern of injury caused by diverse mechanisms, but classifying FSGS accurately can be challenging. In this episode, we provide an overview of these classifications and risk factors that can help stratify disease progression risk and assist with determining management approaches. To help understand how we can most effectively and accurately classify FSGS, we are joined by Professor An De Vriese, who is head of the Division of Nephrology and Infectious Disease at the AZ Sint-Jan hospital in Bruges, Belgium. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at nephrology.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: 1. De Vriese AS et al. Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach. J Am Soc Nephrol 2018;29(3):759-774. 2. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021;100(4S):S1–S276. 3. Jacobs-Cachá C et al. Challenges in primary focal segmental glomerulosclerosis diagnosis: from the diagnostic algorithm to novel biomarkers. Clin Kidney J 2020;14(2):482-491. 4. Friedman DJ & Pollak MR. APOL1 nephropathy: From genetics to clinical applications. CJASN, 2021;16(2):294-303. 5. Zee J et al. APOL1 genotype-associated morphologic changes among patients with focal segmental glomerulosclerosis. Pediatric Nephrology. 2021;36(9):2747-2757. 6. Shabaka A et al. Focal segmental glomerulosclerosis: State-of-the-art and clinical perspective. Nephron 2020;144(9):413-427. Disclosures: Prof. An De Vriese has no disclosures to announce. Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. Funding: This independent educational activity is supported by an educational grant from Travere Therapeutics. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Travere Therapeutics has had no influence on the content of this education.

Shared decision making can play a vital role in the treatment of kidney disease. When physicians involve patients in their care, they may be able to help slow progression and improve outcomes. In this episode, we discussed how patients and their physicians can achieve this and hear stories from patients who have been there.   In this episode, we spoke with:   Ansara Piebenga, parent of a child with kidney disease Ansara Piebenga is the mother of two daughters. Her younger daughter was diagnosed at four months of age with a rare, genetic disease called primary hyperoxaluria. She received a year of daily (seven days a week!) hemodialysis and nightly peritoneal dialysis while being fed only through a gastric-tube.  Once she grew large enough (10 kilograms) she received a combined kidney and liver transplant at Stanford's Lucile Packard Children's Hospital at only 16 months of age.  Ansara's younger daughter is now a teenager who enjoys driving, playing lacrosse, and petting her three dogs.  Her daughter will celebrate 15 years with her transplanted organs this June and their entire family will thank her donor's family once again for their selfless and generous gift.  Ansara has mentored other families facing chronic kidney disease since 2007. She volunteers for Children's Mercy Hospital in Kansas City, the Medical University of South Carolina, the Improving Renal Outcomes Collaborative, Transplant Families, the National Kidney Foundation, the American Society of Pediatric Nephrology, and the American Academy of Pediatrics.    Dr. Susan P. Wong, nephrologist Susan Wong is an Assistant Professor at the University of Washington and a nephrologist and bioethics consultant at the Seattle VA. She leads a research program on treatment practices for advanced kidney disease with a focus on dialysis practices, conservative management without dialysis, and end-of-life and kidney palliative care. When she's not working, she enjoys spending her time gardening and with her 3 beautiful children.   Dr. Taylor House, nephrology fellow Dr. Taylor House is a senior pediatric nephrology fellow at the University of Washington and Seattle Children's Hospital, and she will be joining the faculty at the University of Wisconsin at Madison in the fall. She performs research focused on supporting the flourishing of children with kidney disease and their families through the integration of palliative care into routine nephrology care. She has a specific interest in improving communication between patients, caregivers, and clinicians surrounding kidney disease decision-making.   Elizabeth Fortune, kidney patient Elizabeth Fortune was diagnosed with cancer in 2011. Two significant developments came from her fight with cancer. First, she and her husband started their own non-profit to support fellow cancer survivors and their caregiver. Second, she was left with End-Stage Renal Disease as a result of chemotherapy. She has been on dialysis since her diagnosis in April 2014.  She is a member of NKF's Kidney Advocacy Committee. She also enjoys knitting, reading, writing about her experience with cancer and kidney failure, and traveling with her husband. They also have the greatest cat, Mr. Meowington.  

Sersie and Gigi unpack the truth behind childhood obesity with Dr. Leigh Ettinger. Leigh Ettinger, MD is a pediatric obesity specialist and founder of Doctor Herbivore in New Paltz, New York.  Dr. Ettinger obtained his Doctor of Medicine from Tufts University School of Medicine in 1998 in Boston, Massachusetts, then did a Pediatric Residency at the Children's Hospital at Dartmouth in Lebanon, New Hampshire. He went on to complete his Pediatric Nephrology Fellowship at the Children's Hospital at Montefiore in the Bronx in 2004.  While there he also earned a Masters in Science at the Albert Einstein College of Medicine. Dr. Ettinger is Board Certified in General Pediatrics, Pediatric Nephrology, and Obesity Medicine. He has a certificate in plant-based nutrition from eCornell.  He has been named as a New York Metro Area Top Doctor for the past 6 years.  The Doctor Herbivore practice offers telemedicine appointments to patients in New York and New Jersey ages 2-21 with obesity as well as online educational classes to adults wishing to learn more about the plant-based diet and how to make dietary changes. Connect with Leigh Ettinger, MD: Ettinger@DoctorHerbivore.com Website:  https://doctorherbivore.com/ Facebook Group: www.facebook.com/groups/doctorherbivore/ LinkedIn account: https://www.linkedin.com/in/doctorherbivore/ Instagram: https://www.instagram.com/thedoctorherbivore/ Live Events — Pediatrician | Obesity Specialist (doctorherbivore.com) Blog about B12: https://doctorherbivore.com/is-vitamin-b12-proof-of-a-higher-being/

Barbara Fivush, MD, is our guest on today's episode of the Faculty Factory Podcast. She joins us for an engaging chat about the habits and hacks that have led to her success in academic medicine. She also shares with us some of the wisdom she has gained while launching three different leadership programs for women faculty. With the Johns Hopkins University School of Medicine in Baltimore, Dr. Fivush serves as Senior Associate Dean of Women; Director, Office of Women in Science and Medicine; and Professor of Pediatrics, Division of Pediatric Nephrology.  Learn more about today's episode: https://facultyfactory.org/barbara-fivush

Dr. Augusto Vaglio provides a summary of his study, "Prognostic Factors and Long-Term Outcome with ANCA-Associated Kidney Vasculitis in Childhood," on behalf of his colleagues.

Kathleen Mallett MSN, APRN, FNP-C, CNN-NP discusses pediatric nephrology.

Dr. Sangeeta Hingorani and Dr. David Askenazi summarize findings from their study "Severe Acute Kidney Injury and Mortality in Extremely Low Gestational Age Neonates," on behalf of their colleagues.

Hear Dr. Laster's inspiring story of her journey into medicine. She shares about growing up on the south side of Chicago, competing in beauty pageants, her love of singing (and a demo!), grappling with self-doubt in medical school, what she loves — and doesn't — about her job as a kidney specialist for kids, and how she's come to realize that even the best doctors aren't necessarily smarter than her or anybody else (they just know how to work hard).

The Sediment returns with a very special episode featuring four Barnett Award winners- Drs. Norwood, Mahan, Flynn and Warady describe both the past breakthroughs in pediatric nephrology and where they think we should concentrate our research efforts in the future. Dr. Dharnidharka talks about the man himself - Dr. Barnett! Drs. Sethna and Harshman talk about the ASPN clinical research workshop in Phase 2 that highlighted both the challenges and opportunities to get started in clinical research. Along the way, we have a lot of fun figuring out who is older, which is THE university, and of course, gorillas, dogs and parrots make an appearance as we wonder if we are actually THE American Society of Veterinary Medicine and Pediatric Nephrology!

In the US, cases of ADHD and autism continue to rise. On this episode, pediatric expert Dr. Matthew Hand explains why an integrative approach makes sense. Dr. Hand, who is the Section Chief for Pediatric Nephrology at Children's Hospital at Dartmouth, discusses how diet, lifestyle, and targeted dietary supplements can help treat these conditions.Natural Medicine Journal Podcast is brought to you by Talk 4 Podcasting (www.talk4podcasting.com/) on the Talk 4 Media Network (www.talk4media.com).

In episode 5 of TSC Now, Dan Klein talks to Dr. John Bissler, MD, Clinic Director of the Tuberous Sclerosis Complex Center of Excellence located at Le Bonheur Children’s Hospital, Director of Pediatric Nephrology at the University of Tennessee Health Science Center, and the Medical Director of Nephrology at St. Jude’s Children’s Hospital. They discuss … Continue reading Episode 5: TSC Kidney Manifestations & Consensus Guidelines for Surveillance and Treatment →

I’m delighted to share a conversation we recorded between two wonderful people, Dr Patty Seo Mayer and Dr JJ Zaritsky. Dr Seo Mayer is Medical Director of Pediatric Nephrology at Inova Children’s Hospital and Pediatric Specialists of Virginia, and an Associate Professor of Pediatrics at Virginia Commonwealth University School of Medicine. Dr. Zaritsky is Associate Professor of Pediatrics at Thomas Jefferson University and Chief of Pediatric Nephrology at Nemours duPont Hospital for Children in Wilmington, DE. They have an engaging discussion about pediatric nephrology as a newer field of medicine and describe the people who are drawn to it as naturally empathetic problem solvers.Music by Scott Holmes “Follow Your Dreams” licensed under CC BY-NC 4.0

30 minutes of Renal health, nutrition, care and well- being talk by Professor Dr. Seema Hashmi, who is a Pediatric Nephrologist working at SIUT in Karachi, Pakistan. Dr. Seema talks about preventive care, an ideal renal diet for  adolescents, nursing mothers, kids and adults. In this episode we also touched upon the relationship between Kidneys and pain killers, high protein diets, carbonated drink consumption, healthy bones and blood formation and smoking. Professor Dr. Seema holds a Fellowship in Pediatric Nephrology from the University of Toronto in addition to a Fellowship in General Pediatrics. Her area of research has primarily been genetically transmitted kidney diseases and kidney failure due to renal stones in children. She is a mother of 3 school going children and believes that striking a work life balance is the secret to her success. Her professional aim is to educate the masses so as to prevent kidney diseases altogether. She can be reached at suit.org or seemahashmi2001@gmail.com Give this a listen, and please leave us with a suggestion, rating or review    You can subscribe to our podcast on:    Apple Podcast    Stitcher    Anchor Fm    Google    Spotify 

Carlton Bates, MD, chief of the Division of Pediatric Nephrology, has been caring for children with pediatric kidney disease for many years, but he often finds another organ on his mind: the bladder and the role it plays in the health of a kidney. Dr. Bates discusses his well-recognized research program in Pittsburgh focused on the genetic regulation of kidney and bladder development.

Our guest is Dr. Ken Sutha, MD, a pediatric nephrologist at Lucile Packard Children's Hospital at Stanford. CS: I really get the impression that you feel an obligation because so much has been given to you not only by your father who gave you one of his kidneys, but of course, a recent donor. KS: I’ve always felt it was important for me to pay it forward since I’ve been so fortunate in my journey. Minority communities are disproportionately affected by kidney disease. And so, being able to reach out to the Hispanic community here to share my story as a minority myself, Asian American, also having increased risk of kidney disease. That was a really important thing for me to be able to do.

Some conditions make in-person treatments challenging for patients. Dr. John Bissler, Chief of Pediatric Nephrology and Director of the Tuberous Sclerosis Center of Excellence, discusses how telemedicine benefits patients.

Bradley Warady, MD, Division Chief of Pediatric Nephrology at Children’s Mercy Kansas City is an international leader in pediatric dialysis. In addition to being one of the principal investigators for CKiD, the largest study of pediatric chronic kidney disease ever conducted in North America, Dr. Warady is the lead editor of two authoritative textbooks: Pediatric Dialysis Case Studies and Pediatric Dialysis. He is also on the international committee developing new pediatric dialysis guidelines. In this podcast, Dr. Warady discusses the state of pediatric dialysis today, where improvements can and are being made, and next steps for improving care.

Session 16 This week's guest is Dr. Joel Topf, a private practice and academic Nephrologist who loves teaching and the small details. Back in Episode 06 of the Specialty Stories Podcast, we first covered Nephrology where I talked with Dr. Jean Robey, a private-practice Nephrologist. As you get to listen to both episodes, you will hear some differences in both of those settings. My goal for this podcast is to not just give you insights into what a certain specialty does, but also, for you to see the differences between an academic specialty and a community specialty, or a private-practice physician and be able to compare those different settings. As you go through your medical training, most of the exposure you get is the academic side of medicine and that is not the majority of medicine practiced. Hence, I wanted to give you insights into all of the different aspects of it and be able to compare a private-practice Nephrologist (back in Episode 06) and this episode which is more of an academic Nephrologist. [03:00] Choosing Nephrology Having finished his fellowship in 2003, Dr. Topf is in a hybrid setting where he works for private practice but hired by the hospital to run their fellowship program. He teaches medical students (second to fourth years and the residency program), although it's not a pure academic role since he doesn't do a lot of research. Coming out of medical school, Dr. Topf wanted to do a specialty that allowed him to subspecialize so he chose Med-Peds. It was on the third year of his four-year residency that he decided to do a fellowship and specialize in Nephrology. What led him to this decision is finding how interesting medicine gets and as you study it more, it gets even more interesting. Then before you know it, you can't escape. Dr. Topf was so delighted with Nephrology. However, he was also working on another project, writing a textbook on fluids and electrolytes. So while he was learning a lot of Nephrology, he was also learning a lot of Renal Physiology and fell in love with it. By the time he was choosing his specialty, he felt like Nephrology had picked him more than he picked the specialty and there was nothing else he would ever consider doing. Had he had a more open mind, Critical Care would have been something he considered but he's happy with Nephrology since a lot of the very interesting cases that he likes in Nephrology are shared with Critical Care. [05:35] Traits of a Good Nephrologist Dr. Topf says that the most important trait that leads to being a good nephrologist is being detail-oriented and fastidious since it involves a lot of numbers and balls to keep in the air when you take care of these patients who have a number of problems especially when it comes to dialysis or transplant cases. Most other primary care doctors and specialists want to take their hands off and leave it all up to the Nephrologist to take care of that so you end up being a generalist for a wide span of patients. So even though much time is spent focused on Nephrology, at least in training, Dr. Topf emphasized that you still need to keep your Internal Medicine skills sharp (reason that he re-certified in Internal Medicine). [06:40] A Typical Day Being a Nephrologist Dr. Topf would usually start his day at an outpatient dialysis clinic or two. They see all of their hemodialysis patients once a week and they have around 50 hemodialysis patients. So he goes to a couple of dialysis units in the morning and see a few of his first shift dialysis patients. Next stop is the hospital to see patients through the rest of the morning then have clinic patients in the afternoon. Sometimes in the middle of the day, he would also see dialysis patients on the second shift and at the end of the day, he often stops at the dialysis unit to see patients on a third shift. Hemodialysis patients need to get dialysis three days a week so people are either on a Mon-Wed-Fri schedule or Tues-Thurs-Sat schedule. Each dialysis typically runs about four hours starting somewhere between 5-6 am and the first shift will go from 5-9 am or 6-10 am. Then at 10-11 am, the second shift will go on and then at 2-3 pm, the third shift will go on. Dr. Topf has patients at multiple units on all those different shifts so he has to find a way to see them once a week. [8:20] Types of Patients and Other Procedures In the U.S., 45% of people that are on dialysis get there via diabetes while about 30% get there from hypertension. Essentially, somewhere between two-thirds and three-quarters will be diabetes and hypertension. The rest is everything else that causes kidney disease such as glomerulonephritis, severe kidney injury that never recovers, polycystic kidney disease, cancer, myeloma, etc. Dr. Topf doesn't do procedures that Interventional Nephrologists normally perform. Although during his Fellowship, he did a lot of kidney biopsies and put in a lot of temporary dialysis access. He also has partners that are more interventional who still do kidney biopsies and others put in peritoneal dialysis catheters and hemolysis catheters, but it's not something Dr. Topf likes doing. [10:10] The Academic Aspect of Being a Nephrologist Dr. Topf gives standard lectures every month where he gives a morning report to the residents at their hospital who are in the internal medicine program as well as lectures to their five Nephrology Fellows. He participates in the Fellowship in terms of interviewing and selecting the next year's fellows as well as in evaluating the current fellows. Additionally, he runs one of his outpatient clinics as a fellow clinic so he staffs that fellow in a clinic. He also has a standard role of teaching third year medical students three lecture series as a new group of internal medicine third year students rotate through the hospital for basic nephrology concepts. Another one of his responsibilities in the Fellowship Program is helping coordinate the Fellow Research Projects so these get into fruition. [11:53] Seeing the Two Sides of Nephrology What attracted Dr. Topf to the job was the opportunity to teach as this is something that he really wanted to do. He just didn't want to be locked into the bureaucracy of a traditional academic program with lots of pressure to publish and get grants. So he found this hybrid model that fits the kind of practice that he wanted to do. Basically, it was his practice that became the driving force to bring both of these things to the hospital. [13:00] Work-Life Balance Dr. Topf describes his Nephrology practice as enjoyable. It's more of a traditional physician model where he doesn't have set hours and has a call generally once a month with certain exceptions such as when a partner gets sick or death in a family so he would have to get calls twice or thrice a month, which happens rarely. But nephrology in general is more of a traditional internist model. It's not a hospitalist nor an E.R, doc so you're not punching in or out. Dr. Topf describes himself as a business owner so he works harder because he owns it and the work he puts in is delivered back to him in monetary rewards. When he gets a call, he covers all the patients in the hospital so he typically sees somewhere between 20 and 30 patients in the hospital each day that he is on call, which would be a full day. [14:55] The Path to Residency and Fellowship If you want to be a pediatric nephrologist, you need to do three years of internal medicine and then you need to get a Nephrology Fellowship, which is traditionally three years long (Commonly today, there are two years now.) In the old model, it consists of one year clinical and two years of research. For most fellowships now, it's two years of clinical experience with some clinical research in the second year. During his adult fellowship, he spent a lot of time doing Pediatric Nephrology where he did special rotations at the children's hospital and got a lot of experience. What he found out from that experience is that it really is a different specialty. There is a crossover but there isn't all that much because the diseases they see are quite a bit different. If he lived in an area that didn't have a pediatric nephrologist, he would absolutely see children but he lives in Detroit where there is a children's hospital two to four miles away from his hospital so it would be absurd for parents to take their kid to see an adult nephrologist when there is a pediatric nephrologist right next door. He did think about doing it early on in their training but as he began to appreciate what being a specialist really meant, it made less and less sense for him. If you want to be a generalist, don't sub-specialize. If you want to be a specialist well then you need to be a specialist where you need to focus on just the patients that you're going to be taking care of. Why he chose adult nephrology over pediatric nephrology is primarily because of the way higher demand for an adult nephrologist. He has heard stories of people finishing pediatric nephrology fellowships and not being able to find a job or they're not able to use that training having to spend for years waiting for a position to open up so in meantime would have to do general pediatric work so they don't get to use their training. [18:30] Competitiveness of Nephrology Fellowship and the Hospitalist Boom A nephrology fellowship is not competitive, in fact, Dr. Topf reckons it's close to two nephrology spots for every one applicant. So it's absolutely a buyer's market. Therefore, the residents are in great positions where they will definitely get offered interviews everywhere and they will be able to put a very aggressive rank list since there would still be a match system. Very few people who want to be a nephrologist are unable to become a nephrologist. What they want to see in nephrology fellowship applicants is somebody who has a strong desire to be a nephrologist rather than just someone who sees it as a fallback. They're looking for someone who really loves the specialty and wants to be a nephrologist and not just what's available to them. This is demonstrated through a research experience in nephrology or letters of recommendation from fellow Nephrologists they know or have done rotations in their institution or they've contacted them early on and shown interest to it. All these could put any applicant way higher on the rank list. Six years ago, they had 200 applicants for their two to three spots a year but the number has waned this year to just 22. The demand thereby fell off to 90% in six years. Dr. Topf’s theory is that this could be caused by the hospitalist boom, a huge new specialty that emerged from nowhere that they have to staff up every resident plus they pay excellent salaries, offer shift work, and they start getting paid the next day their residency ends. Whereas in a nephrology fellowship, you have two more years of postgraduate training to go through and then you get a job where you're going to work more than 40 hours  a week. Compared to a cardiologist or a G.I. doctor that gets a much higher salary than as a hospitalist but at the end of a nephrology rainbow, the salary may just be modestly better or the same as with a hospitalist. [22:30] Subspecialty Opportunities Subspecialties available include Transplant Certified, which happens one year after fellowship, and Interventional Nephrology, which is less regulated. Some fellowships do that, others have two or three-month courses run by dialysis access companies that give them all the training needed for those procedures (no board certification for that). Others do Hypertension subspecialties, which is just a test given by the American Society of Hypertension. You can do fellowship and get formal training for it but a lot of people just take the test and gain that certification. [23:45] Primary Care and Other Specialties Dr. Topf thinks primary care physicians are doing a good job with it but they should be more aggressive with hypertension and less aggressive with glycemic control since he sees a lot of patients suffering from over-emphasis on trying to get the A1c all the way down causing a lot of hypoglycemic spells. But these are style issues more than knowledge gaps. Among other specialties he works closest with include critical care, E.R. cardiology and endocrinology. They also get consults for the same diseases oftentimes such as hypercalcemia. [26:10] Special Opportunities Outside of Clinical Medicine A huge opportunity outside of clinical medicine is a Dialysis Medical Director. There are thousands of dialysis units around the country that cannot operate without a medical director. Medical directors need to be board-certified in Nephrology. Dr. Topf adds that this is a different type of medicine than you've ever practiced before since you will be providing population health and be looking at all the infections that happened in, say, 80 patients there that month and try to find patterns causing these infections. They also have to go over the water treatment system considering the massive amount of water used in dialysis, meaning 5,760 liters per shift and you run three shifts per day so that is close to 20,000 liters of water being treated in a dialysis unit everyday. Keeping all that equipment up-to-date and functioning is a continual exercise and you have experts that help you with it but the medical director is at the top of all those experts to make sure they're doing a good job and doing all the reports on water quality, infections, and meeting targets in hemoglobin, albumin, and phosphorus. You will also be working with a Nutritionist or a social worker. Apparently, there are a lot of different benchmarks of a dialysis quality and as a medical director, you're responsible for those. [29:30] The Best and Least Good Thing Dr. Topf finds being a nephrologist to be a rewarding career for him. His advice to a brand new nephrologist is that your first few years coming out of Fellowship are still a major learning moment. You are nowhere near the top of the mountain so there's still a lot of learning you need to do so be humble. What he loves best about being a nephrologist is the teaching side of it. He also loves having that longitudinal experience with his patients where he is able to see and take care of patients through all the different phases of their kidney disease. On the flip side, what he likes least about being a nephrologist is those four dialysis visits a month for each dialysis patient which he considers as an overkill. He thinks he didn't need to do this that much since you could do all the medically important stuff in just two visits but this is a requirement(which is also a reimbursement-driven thing) that ends up being unnecessarily burdensome for him . [32:15] The Future of Nephrology The advancements in technology and techniques taking over much of the diseases have significantly reduced the numbers of procedures needed in treating diseases related to, for example, cardiology. Nephrology is highly dependent on dialysis so if a new technology comes on, whether it would eliminate dialysis or dramatically reduce its need would be a major earthquake for the specialty. Nanotechnology creating smaller filters to create a transplantable artificial kidney is something he doesn't see being viable for a long time. It sounds cool but it doesn't really address the biggest problem with current dialysis which is access, the mere process of getting the blood in and out of the body safely. Unfortunately, this technology doesn't address that. [35:30] Final Words of Wisdom If he had to choose Nephrology again, he would still have chosen it in a second. Lastly, Dr. Topf wants students to know that if they find the kidney to be interesting but intimidating because of how difficult it is, then it's not that difficult. You will be able to learn the kidney from its very fundamentals when you go to fellowship and you will be building a model of it in your brain. Once you have that model, everything makes sense and it all falls into place. That is difficult to understand how much simpler everything will be when that happens. Once you get it, you get it and it's not very hard. If you're interested in it, pursue it because it's not that hard. [36:40] Bias Among DOs and Caribbean Graduates Dr. Topf said that they have a DO on the board in their practice and will likely be the next CEO. Their assistant program director is also a DO. So there no bias, not even close to having a bias. They also have a Caribbean graduate who is an excellent doctor as a partner. Links: Get connected with Dr. Joel Topf on Twitter @kidney_boy. Shoot me an email at ryan@medicalschoolhq.net MedEd Media Network Specialty Stories Podcast Episode 06: A Private-Practice Nephrologist Talks About Her Job American Society of Hypertension

Pediatric Grand Rounds with Pierre Cochat, MD. Dr. Cochat President of the International Pediatric Nephrology Association and Professor and Division Director of Pediatric Nephrology at the Lyon University in France