[Nephrology: what's new in 2021?]

Area of Science:

• Nephrology
• Renal Medicine
• Immunology

Background:

• Significant progress has been made in managing nondiabetic chronic kidney disease and ANCA-associated renal vasculitis.
• Existing GFR estimation formulas often incorporate ethnicity, potentially introducing bias.
• Optimal management strategies for dialysis patients, transplant recipients, and vaccine efficacy in immunocompromised populations remain areas of active research.

Purpose of the Study:

• To review and synthesize recent major advances in nephrology treatment and patient management.
• To highlight new developments in GFR assessment, dialysis therapies, anticoagulation, immunosuppression, and vaccine response.

Main Methods:

• Literature review of major publications within the past two years focusing on nephrology.
• Synthesis of findings related to chronic kidney disease, ANCA-associated vasculitis, hemodialysis, kidney transplantation, and infectious disease in renal patients.

Main Results:

• A novel GFR formula has been developed, eliminating the need for ethnicity adjustments.
• Hemodiafiltration shows no detrimental effect on uremic neuropathy in hemodialysis patients.
• Direct oral anticoagulants (DOACs) demonstrate a lower bleeding risk compared to vitamin K antagonists in hemodialysis patients.
• Rapid steroid weaning is suggested for select kidney transplant recipients.
• COVID-19 vaccination efficacy is reduced in dialysis and transplant patients, indicating a need for a third dose.

Conclusions:

• Recent advances offer improved GFR assessment, safer anticoagulation, and potentially optimized immunosuppression protocols in nephrology.
• Hemodiafiltration is a viable option for hemodialysis patients without compromising neurological outcomes.
• Immunocompromised renal patients require tailored vaccination strategies, including additional doses, to achieve adequate protection against COVID-19.