This more frequent diagnosis is only partially accounted for by African-American carriers of the APOL1 risk variant, as the frequency of hypertensive nephropathy is also higher in US whites and others (mostly Asians) than in Europe and Japan. Note the more frequent diagnosis of hypertensive nephropathy in the USA. Percentage of incident patients starting RRT because of hypertensive nephropathy in the 2017 ERA-EDTA, Japanese and US Renal Data System registries. The fact that we can escape so easily from recognizing that we do not know what caused CKD in the patient sitting in front of us will contribute to delay progress in aetiological diagnosis and personalized medicine in nephrology. This means that a diagnosis of hypertensive nephropathy essentially means CKD of unknown origin in a patient with hypertension, thus potentially relegating a diagnosis of CKD of unknown origin to the scarce CKD patients that do not have hypertension. Additionally, since the two key diagnostic requirements are hypertension and chronic kidney disease (CKD) and >80% of CKD patients develop hypertension, CKD patients with hypertension will fulfil diagnostic criteria for hypertensive nephropathy, especially when no diagnostic workup is made. This is contrary to the spirit of aetiological diagnosis. However, hypertensive nephrosclerosis remains a diagnosis of exclusion, which, in practical terms, means that the lower the quality of the aetiologic diagnostic workup, the higher the chances of being diagnosed as hypertensive nephrosclerosis. Hypertensive nephrosclerosis is also the second most frequent cause of RRT in the USA and the third in Japan ( Figure 1). In recent years, hypertension has been the second or third most common cause of renal replacement therapy (RRT) in Europe, tied with glomerulonephritis. This issue of Clinical Kidney Journal contains the summary of the 2017 Annual Report of the ERA-EDTA Registry.
ROADBLOCK 2017 FULL
A diagnosis of nephropathy of unknown cause would be more honest when the full range of alternative aetiological diagnoses is not explored.Īlport, autosomal dominant tubulointerstitial disease, cause, glomerulonephritis, hypertension, nephrosclerosis, registry, renal replacement therapy HYPERTENSIVE KIDNEY DISEASE AS THE SECOND MOST COMMON NEPHROPATHY REQUIRING RRT: CAN THIS STATEMENT BE MAINTAINED IN THE 21ST CENTURY? Correct causality assessment and aetiology-based therapy is a key to the progress of nephrology and it should no longer be accepted that ‘hypertensive nephropathy’ serves to disguise a suboptimal diagnostic workup. There is an urgent need to redefine the concept of hypertensive nephropathy with a clear and comprehensive set of criteria that at least should indicate how other nephropathies, including familial nephropathies, should be excluded. It is not helpful that 80% of chronic kidney disease patients develop hypertension and kidney biopsy has no findings specific for hypertensive nephropathy. The current definition of hypertensive nephropathy is non-specific, outdated and only allows a delayed diagnosis by exclusion. In this regard, the incidence of RRT due to hypertensive nephropathy is related to the incidence of other causes of ESRD but not to the burden of hypertension per country. There is, however, one little issue: hypertension-induced end-stage renal disease (ESRD) might not exist at all as currently understood, that is, as hypertensive nephrosclerosis. This Note proposes that ERISA needs to be waived, amended or repealed so that states can implement meaningful healthcare reforms under §1332.In the 2017 Annual Report of the ERA-EDTA Registry, hypertension continues to be the second or third most common cause of renal replacement therapy (RRT) in Europe, tied with glomerulonephritis. Also, if a state law limits employer choices too much, it will likely violate ERISA.
State laws cannot directly refer to ERISA, nor influence the benefits, administration, or structure of an ERISA plan. This Note explores the ways in which ERISA presents significant roadblocks to meaningful state level healthcare reform under §1332. Because of ERISA, the regulation of employee benefit plans, including health plans, falls primarily under federal jurisdiction for about 131 million people. The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to encourage employers to sponsor benefit plans and minimize potential conflicts with existing state laws. In 2017, the Affordable Care Act’s (ACA) State Innovation Waiver (§1332) will enable states to waive many of the ACA’s provisions and to develop their own creative solutions to reign in healthcare spending.
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