Nephrology: The Complete 2024 Guide 🧬

1. Kidney Function Fundamentals

1.1 Key Metrics & Ranges

Test	Normal Range	Critical Value
GFR	≥90 mL/min	<15 (ESRD)
Creatinine	0.6-1.2 mg/dL	>4.0 (Emergency)
Albuminuria	<30 mg/g	>300 (Nephrotic)

2024 Update:

Cystatin C now preferred over creatinine for GFR (10% more
accurate)

1.2 Kidney Anatomy

Nephrons: 1 million/kidney → Filter 180L daily

Glomerulus: Blood filtration (Podocyte damage = proteinuria)

Tubules: Reabsorb 99% filtrate (Electrolyte balance)

2. Chronic Kidney Disease (CKD)

2.1 KDIGO Staging 2024

Stage	GFR	Action
G1	>90	Monitor risk factors
G3a	45-59	Nephrology referral
G5	<15	Dialysis/transplant 💉

Alarming Stats:

37M Americans have CKD (90% undiagnosed)

Diabetes causes 44% of ESRD cases

2.2 Slowing Progression

SGLT2 Inhibitors: Reduce decline by 35% (Farxiga)

Diet: <0.8g/kg protein + <2g sodium

BP Control: Target <130/80 mmHg (ACEi/ARB first-line)

3. Acute Kidney Injury (AKI)

3.1 KDIGO Criteria

Creatinine rise ≥0.3 mg/dL in
48hrs

Urine output <0.5 mL/kg/hr for 6hrs

Common Causes:

Sepsis (45%)

Nephrotoxins (NSAIDs, contrast)

Hypovolemia

Novel Biomarkers:

TIMP-2•IGFBP7 predicts AKI 12hrs earlier (NephroCheck®)

4. Dialysis Options

4.1 Modality Comparison

Type	Frequency	Survival Rate	Lifestyle Impact
Hemodialysis	3x/week	5-yr 35%	Clinic-bound
Peritoneal	Daily	5-yr 45%	Home-based
Nocturnal HD	6x/week	5-yr 60%	Better clearance 🌙

2024 Innovation:

Wearable artificial kidney in Phase III trials (2kg device)

5. Kidney Transplants

5.1 2024 Protocols

Living donors: 3-5 yr longer graft survival

HLA matching: Less critical with modern immunosuppressants

New Drugs:

Belatacept (No
nephrotoxicity)

Tocilizumab (Anti-rejection)

Survival Rates:

Deceased donor: 85% at 1yr, 50% at 10yr

Living donor: 95% at 1yr, 70% at 10yr

5.2 Paired Exchange Programs

Algorithmic matching (3-way swaps common)

Global networks: 40+ countries participating

 

6. Glomerular Diseases

6.1 Diagnostic Workup

 

Common Diagnoses:

MCD (Steroid-sensitive)

FSGS (20% progress to ESRD)

Membranous (PLA2R antibody-positive)

6.2 Novel Therapies

Sparsentan (FSGS): 50% proteinuria reduction

Rituximab (Membranous): 80% remission rate

7. Electrolyte Disorders

7.1 Quick Reference

Disorder	Treatment	Emergency Action
Hyperkalemia	Calcium gluconate → Insulin+D50	ECG changes → Dialysis
Hyponatremia	3% NaCl if neuro symptoms	Correct ≤6-8 mEq/day
Metabolic Acidosis	NaHCO3 if pH<7.2	Address root cause

2024 Tool:

Urine anion gap distinguishes renal vs non-renal causes

8. Prevention & Screening

8.1 High-Risk Groups

Diabetes: Annual UACR + serum
Cr

Hypertension: Screen if >140/90 mmHg

Family History: APOL1 gene testing (African ancestry)

8.2 Dietary Guidelines

Fluids: 2-3L/day (Adjust for dialysis)

Potassium: <2g/day if CKD4+ (Avoid bananas, potatoes)

Phosphorus: <800mg/day (Limit dairy, soda)

Resources

Patient Tools

NKF GFR Calculator (Online/mobile)

MyFoodData (Phosphorus tracker)

Professional Societies

ASN (American Society of
Nephrology)

ERA-EDTA (European Renal Assoc.)