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Article ; Online: Current Trends and Challenges in Nephrology Fellowship Training: Expansion of Education in Home Dialysis, Palliative Care, and Point-of-Care Ultrasound.

Greenberg, Keiko I / Pourafshar, Negiin / Choi, Michael J

2022 Volume 29, Issue 6, Page(s) 510–515

Abstract: Nephrology education has changed significantly since the first nephrology fellowship programs were established in the United States in the 1950s and 1960s. The past several years have seen increased opportunities for subspecialization in areas such as ... ...

Abstract	Nephrology education has changed significantly since the first nephrology fellowship programs were established in the United States in the 1950s and 1960s. The past several years have seen increased opportunities for subspecialization in areas such as interventional nephrology, onconephrology, and glomerular disease. Notable trends in fellowship curricula include the expansion of education in home dialysis and palliative care, driven by policy changes and focus on patient-centered care. In addition, point-of-care ultrasound has garnered significant interest due to its potential to provide diagnostic information that improves patient care. An important area that remains largely unaddressed appears to be education about the business and administrative aspects of nephrology. Meanwhile, the importance of training in hemodialysis catheter placement and kidney biopsy has come into question due to the small proportion of nephrologists performing these procedures today. Nephrology fellowship programs should strive to tailor their curriculum to meet the interests and needs of individual fellows.
MeSH term(s)	Humans ; United States ; Fellowships and Scholarships ; Nephrology/education ; Palliative Care ; Hemodialysis, Home ; Point-of-Care Systems ; Curriculum
Language	English
Publishing date	2022-11-21
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1548-5609 ; 1548-5595
ISSN (online)	1548-5609
ISSN	1548-5595
DOI	10.1053/j.ackd.2022.07.006
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Article ; Online: Pseudohyperkalemia: Three Cases and a Review of Literature.

Saleh-Anaraki, Kimia / Jain, Anjuli / Wilcox, Christopher S / Pourafshar, Negiin

The American journal of medicine

2022 Volume 135, Issue 7, Page(s) e150–e154

Abstract: Hyperkalemia is a potentially fatal complication requiring prompt diagnosis and management. However, pseudohyperkalemia, defined as an artificial rise in serum potassium ( ... ...

Abstract	Hyperkalemia is a potentially fatal complication requiring prompt diagnosis and management. However, pseudohyperkalemia, defined as an artificial rise in serum potassium (S
MeSH term(s)	Blood Specimen Collection ; Humans ; Hyperkalemia/diagnosis ; Hyperkalemia/etiology ; Hyperkalemia/therapy ; Leukocytosis ; Potassium ; Thrombocytosis
Chemical Substances	Potassium (RWP5GA015D)
Language	English
Publishing date	2022-04-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2022.01.036
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Article ; Online: Etiology and Management of Edema: A Review.

Koirala, Abbal / Pourafshar, Negiin / Daneshmand, Arvin / Wilcox, Christopher S / Mannemuddhu, Sai Sudha / Arora, Nayan

Advances in kidney disease and health

2023 Volume 30, Issue 2, Page(s) 110–123

Abstract: The development of peripheral edema can often pose a significant diagnostic and therapeutic challenge for practitioners due to its association with a wide variety of underlying disorders ranging in severity. Updates to the original Starling's principle ... ...

Abstract	The development of peripheral edema can often pose a significant diagnostic and therapeutic challenge for practitioners due to its association with a wide variety of underlying disorders ranging in severity. Updates to the original Starling's principle have provided new mechanistic insights into edema formation. Additionally, contemporary data highlighting the role of hypochloremia in the development of diuretic resistance provide a possible new therapeutic target. This article reviews the pathophysiology of edema formation and discusses implications for treatment.
MeSH term(s)	Humans ; Causality ; Acid-Base Imbalance ; Diuretics ; Edema
Chemical Substances	Diuretics
Language	English
Publishing date	2023-03-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	3156601-7
ISSN	2949-8139
ISSN (online)	2949-8139
DOI	10.1053/j.akdh.2022.12.002
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Article ; Online: Pathways to improve nephrologist comfort in managing patients on in-center or home self-care dialysis.

Huang, Minghui / Vincent Johnson, Anita / Pourafshar, Negiin / Malhotra, Rakesh / Yang, Jason / Shah, Monarch / Balogun, Rasheed / Chopra, Tushar

Hemodialysis international. International Symposium on Home Hemodialysis

2023 Volume 27, Issue 3, Page(s) 204–211

Abstract: In end-stage kidney disease (ESKD), patient engagement and empowerment are associated with improved survival and complications. However, patients lack education and confidence to participate in self-care. The development of in center self-care ... ...

Abstract	In end-stage kidney disease (ESKD), patient engagement and empowerment are associated with improved survival and complications. However, patients lack education and confidence to participate in self-care. The development of in center self-care hemodialysis can enable motivated patients to allocate autonomy, increase satisfaction and engagement, reduce human resource intensiveness, and cultivate a curiosity about home dialysis. In this review, we emphasize the role of education to overcome barriers to home dialysis, strategies of improving home dialysis utilization in the COVID 19 era, the significance of in-center self-care dialysis (e.g., cost containment and empowering patients), and implementation of an in-center self-care dialysis as a bridge to home hemodialysis (HHD).
MeSH term(s)	Humans ; Renal Dialysis ; Self Care ; Nephrologists ; COVID-19 ; Kidney Failure, Chronic/therapy ; Hemodialysis, Home
Language	English
Publishing date	2023-05-08
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	2192458-2
ISSN	1542-4758 ; 1492-7535
ISSN (online)	1542-4758
ISSN	1492-7535
DOI	10.1111/hdi.13093
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Article ; Online: Signals From Inflamed Perivascular Adipose Tissue Contribute to Small Vessel Dysfunction in Women Living With the Human Immunodeficiency Virus.

Wilcox, Christopher S / Herbert, Carly / Wang, Cheng / Ma, Yuchi / Sun, Philena / Li, Tian / Verbesey, Jennifer / Kumar, Princy / Kassaye, Seble / Welch, William J / Choi, Michael J / Pourafshar, Negiin / Wang, Dan

The Journal of infectious diseases

2024

Abstract: Introduction: People living with the human immunodeficiency virus (PWH) have microvascular disease. Since perivascular adipose tissue (PVAT) regulates microvascular function and adipose tissue is inflamed in PWH, we tested the hypothesis that PWH have ... ...

Abstract	Introduction: People living with the human immunodeficiency virus (PWH) have microvascular disease. Since perivascular adipose tissue (PVAT) regulates microvascular function and adipose tissue is inflamed in PWH, we tested the hypothesis that PWH have inflamed PVAT that impairs the function of their small vessels. Methods: Subcutaneous small arteries were dissected with or without (+ or -) PVAT from a gluteal skin biopsy from 11 women with treated HIV (WWH) aged < 50 years and 10 matched women without HIV and studied on isometric myographs. Nitric oxide (NO) and reactive oxygen species (ROS) were measured by fluorescence microscopy. Adipokines and markers of inflammation and ROS were assayed in PVAT. Results: PVAT surrounding the small arteries in control women significantly (P < 0.05) enhanced acetylcholine (Ach)-induced endothelium dependent relaxation and NO and reduced contractions to thromboxane and endothelin-1. However, these effects of PVAT were reduced significantly (P < 0.05) in WWH whose PVAT released less adiponectin but more markers of ROS and inflammation. Moderation of contractions by PVAT were correlated positively with adipose adiponectin. Conclusion: PVAT from WWH has oxidative stress, inflammation and reduced release of adiponectin that may contribute to enhanced contractions and therefore could promote small artery dysfunction.
Language	English
Publishing date	2024-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	3019-3
ISSN	1537-6613 ; 0022-1899
ISSN (online)	1537-6613
ISSN	0022-1899
DOI	10.1093/infdis/jiae094
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Article ; Online: Urine Ammonium, Metabolic Acidosis and Progression of Chronic Kidney Disease.

Pourafshar, Negiin / Pourafshar, Shirin / Soleimani, Manoocher

Nephron

2017 Volume 138, Issue 3, Page(s) 222–228

Abstract: The metabolism of a typical Western diet generates 50-100 mEq of acid (H+) per day, which must be excreted in the urine for the systemic acid-base to remain in balance. The 2 major mechanisms that are responsible for the renal elimination of daily acid ... ...

Abstract	The metabolism of a typical Western diet generates 50-100 mEq of acid (H+) per day, which must be excreted in the urine for the systemic acid-base to remain in balance. The 2 major mechanisms that are responsible for the renal elimination of daily acid under normal conditions are ammonium (NH4+) excretion and titratable acidity. In the presence of systemic acidosis, ammonium excretion is intensified and becomes the crucial mechanism for the elimination of acid. The impairment in NH4+ excretion is therefore associated with reduced acid excretion, which causes excess accumulation of acid in the body and consequently results in metabolic acidosis. Chronic kidney disease (CKD) is associated with the impairment in acid excretion and precipitation of metabolic acidosis, which has an adverse effect on the progression of CKD. Recent studies suggest that the progressive decline in renal ammonium excretion in CKD is an important determinant of the ensuing systemic metabolic acidosis and is an independent factor for predicting the worsening of kidney function. While these studies have been primarily performed in hypertensive individuals with CKD, a closer look at renal NH4+ excretion in non-hypertensive individuals with CKD is warranted to ascertain its role in the progression of kidney disease.
MeSH term(s)	Acid-Base Imbalance/complications ; Acid-Base Imbalance/etiology ; Acidosis/complications ; Acidosis/urine ; Ammonium Compounds/urine ; Disease Progression ; Humans ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/urine
Chemical Substances	Ammonium Compounds
Language	English
Publishing date	2017-10-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000481892
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Article ; Online: Thiazide Therapy in Chronic Kidney Disease: Renal and Extra Renal Targets.

Pourafshar, Negiin / Alshahrani, Saeed / Karimi, Ashkan / Soleimani, Manoocher

Current drug metabolism

2018 Volume 19, Issue 12, Page(s) 1012–1020

Abstract: Background: Thiazides are the most commonly used medications for the treatment of mild and moderate hypertension. Despite their recognized effect, the mechanism by which thiazides reduce systemic blood pressure remains uncertain. The prevailing belief ... ...

Abstract	Background: Thiazides are the most commonly used medications for the treatment of mild and moderate hypertension. Despite their recognized effect, the mechanism by which thiazides reduce systemic blood pressure remains uncertain. The prevailing belief is that thiazides reduce blood pressure primarily via enhancement of salt excretion consequent to the inhibition of the Na-Cl Cotransporter (NCC) in the Distal Convoluted Tubules (DCT). However, recent reports point to a reduction in peripheral vascular resistance as a major mechanism of antihypertensive effect of thiazides. It is plausible that both mechanisms, renal and extra-renal, may be operating simultaneously. Recent studies point to compensatory mechanisms in the kidney distal nephron that may play a role in blunting the diuretic effect of thiazides. Not much information is available about the efficacy of thiazides in controlling blood pressure in individuals with Chronic Kidney Disease (CKD). Objective: This review will discuss the latest updates on the use and efficacy of thiazides derivatives as diuretics and antihypertensive medications in CKD patients. Conclusion: Thiazides remain effective as diuretics and antihypertensive agents in individuals with low GFR.
MeSH term(s)	Animals ; Antihypertensive Agents/pharmacology ; Antihypertensive Agents/therapeutic use ; Diuretics/pharmacology ; Diuretics/therapeutic use ; Humans ; Kidney/drug effects ; Renal Insufficiency, Chronic/drug therapy ; Thiazides/pharmacology ; Thiazides/therapeutic use
Chemical Substances	Antihypertensive Agents ; Diuretics ; Thiazides
Language	English
Publishing date	2018-07-18
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2064815-7
ISSN	1875-5453 ; 1389-2002
ISSN (online)	1875-5453
ISSN	1389-2002
DOI	10.2174/1389200219666180702104559
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Article ; Online: Need for Raising Awareness - Monitoring Urinary Protein Excretion in Cardiac Transplant Patients Receiving Mammalian Target of Rapamycin Inhibitors.

Pourafshar, Negiin / Karimi, Ashkan / Gregg, Jon / Kazory, Amir

Nephron

2017 Volume 135, Issue 2, Page(s) 154–155

MeSH term(s)	Everolimus/adverse effects ; Heart Transplantation/adverse effects ; Humans ; Immunosuppressive Agents/adverse effects ; Proteinuria/chemically induced ; Risk Factors ; Sirolimus/adverse effects ; TOR Serine-Threonine Kinases/antagonists & inhibitors
Chemical Substances	Immunosuppressive Agents ; Everolimus (9HW64Q8G6G) ; MTOR protein, human (EC 2.7.1.1) ; TOR Serine-Threonine Kinases (EC 2.7.1.1) ; Sirolimus (W36ZG6FT64)
Language	English
Publishing date	2017
Publishing country	Switzerland
Document type	Letter
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000452170
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Article ; Online: A case of isolated renal involvement of polyarteritis nodosa successfully treated with steroid monotherapy.

Pourafshar, Negiin / Sobel, Eric / Segal, Mark

BMJ case reports

2016 Volume 2016

Abstract: Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis that affects medium-sized and small-sized arteries. The spectrum of disease ranges from involving a single organ to polyvisceral failure. We report a case of a 75-year-old male presented ... ...

Abstract	Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis that affects medium-sized and small-sized arteries. The spectrum of disease ranges from involving a single organ to polyvisceral failure. We report a case of a 75-year-old male presented with solely hypertension and mild renal function impairment as a consequence of diffuse renal necrotising vasculitis with occlusive but non-stenotic lesions associated with PAN. The overall prognosis of PAN has been improved in recent decades, primarily reflecting early diagnosis and more effective treatments. Therefore, early diagnosis is critical and it warrants full investigations even in those patients without obvious multiorgan manifestations. In those instances, with mild disease, steroid monotherapy has been shown to be effective with excellent response. Our patient responded well to steroid monotherapy and we were able to gauge his response by improvement in his blood pressure.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Aged ; Humans ; Kidney Diseases/complications ; Kidney Diseases/drug therapy ; Male ; Polyarteritis Nodosa/complications ; Polyarteritis Nodosa/drug therapy ; Treatment Outcome
Chemical Substances	Adrenal Cortex Hormones
Language	English
Publishing date	2016-07-20
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2016-215702
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Article ; Online: Extracorporeal ultrafiltration therapy for acute decompensated heart failure.

Pourafshar, Negiin / Karimi, Ashkan / Kazory, Amir

Expert review of cardiovascular therapy

2016 Volume 14, Issue 1, Page(s) 5–13

Abstract: Congestion is the most common reason for hospitalization of patients with acute decompensated heart failure (ADHF) and adversely impacts their outcomes. Extracorporeal ultrafiltration (UF) therapy has re-emerged as an effective strategy for decongestion ... ...

Abstract	Congestion is the most common reason for hospitalization of patients with acute decompensated heart failure (ADHF) and adversely impacts their outcomes. Extracorporeal ultrafiltration (UF) therapy has re-emerged as an effective strategy for decongestion in this setting. This article is intended to discuss key concepts in UF and its technique, provide a brief historical view of UF application for decongestion in ADHF, review the hemodynamic and neurohormonal effects of UF and their positive effects on the pathophysiology of ADHF, discuss the findings of the landmark trials in this field, and explain key findings of these studies as well as the apparent discrepancies in their findings. In a separate section we discuss the intricacies of renal dysfunction in ADHF as it plays a very important role in understanding the current evidence and designing futures clinical trials of UF in ADHF. In the end, the authors provide their perspective on the future role of UF in management of patients with ADHF and congestion.
MeSH term(s)	Extracorporeal Circulation/methods ; Heart Failure/physiopathology ; Heart Failure/therapy ; Hemodynamics ; Humans ; Kidney/physiopathology ; Symptom Flare Up ; Ultrafiltration/methods
Language	English
Publishing date	2016
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2192343-7
ISSN	1744-8344 ; 1477-9072
ISSN (online)	1744-8344
ISSN	1477-9072
DOI	10.1586/14779072.2016.1110020
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