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Garabed Eknoyan

Publications and source records attributed to Garabed Eknoyan.

44 records · Page 3Linked to original sources
PubMed2002

Impact of the new K/DOQI guidelines.

During the course of developing clinical practice guidelines to improve outcomes of dialysis patients, it became evident that there existed an even greater opportunity to improve outcomes for all individuals with kidney disease, from the earliest stage of kidney injury through the entire spectrum of its progression to kidney failure, when replacement therapy becomes necessary. The development and adoption of a public health approach to the progressive course of chronic kidney disease could allow for the application of interventional strategies to prevent the loss of kidney function in some cases, to slow the progression of kidney disease in many others, and to ameliorate the complication or comorbidities in those with progressive kidney disease. In order to respond to this need, a new initiative, termed the Kidney Disease Outcomes Quality Initiative (K/DOQI), was launched in January of 2000. This article summarizes the recommendations of the first three set of clinical practice guidelines being developed under this new initiative: Chronic Kidney Disease: Evaluation, Classification and Stratification; Bone Metabolism and Disease in Chronic Kidney Disease, and Dyslipidemias in Kidney Failure.

Bone Diseases, Metabolic↗
PubMed2002

Emergence of the concept of acute renal failure.

Acute renal failure (ARF) is an ailment that has afflicted humans from time immemorial. Its recognition, however, was slow to emerge, hampered initially by the failure to consider it a diagnosis and, subsequently, by the disparity of its nomenclature in the different conditions in which it was observed and described. Further delay was due to the late recognition of the physiology of urine formation and the pathophysiology of acute injury to the kidney, which was to allow the final identification of the entity in the past century. The definition of "ischuria" as the suppression or retention of urine, and its classification to include "ischuria renalis" in the 17th century was a fundamental step that allowed diseases of the kidney to be grouped, studied and described. By the 18th century, the clinical course of ARF was well described, and by the 19th century its microscopic structural features were clearly detailed but continued to be given disparate names by various authors. During World War I, acute failure of kidney function due to trauma was reported as "war nephritis", which with the end of the war became a forgotten entity. In the interval between the two world wars, increased emphasis on experimental studies allowed major advances in the understanding of the hemodynamics of shock, volume homeostasis, kidney function and tubular epithelial cell injury and regeneration. As such, the reports of acute kidney failure in crush victims of the London air raids in 1941 prompted a series of clinical, pathological and experimental studies over the ensuing decade that were to lead to the full emergence of the concept of ARF in 1951.

Acute Kidney Injury↗
PubMed2002

Rufus of Ephesus and his "Diseases of the Kidneys".

The first book on diseases of the kidneys, titled "Diseases of the Kidneys and Bladder", was written by Ruphus of Ephesus at the close of the 1st century AD. Little is known of Rufus, who seems to have attained fame and was considered an equal of Hippocrates and Galen. He was highly respected and extensively quoted by authors of Byzantine, Arabic and Middle Ages medicine. In his description of diseases of the kidneys he makes a concerted effort to correlate structure and function, and to provide a rational explanation of the altered function of the kidneys in disease. The section of his monograph "On Hardening of the Kidneys" is brief, but constitutes the first description of morbid and clinical features of the end-stage kidneys. Like many of his contemporaries, Rufus wrote several monographs on selected topics and organs. That he chose diseases of the kidneys as the subject of one of his monographs makes him especially pertinent to the history of nephrology.

History, Ancient↗
PubMedDate not supplied

Francis Delafield (1841-1915): the original contributions of an American investigator to diseases of the kidney.

The growth of our knowledge of diseases of the kidney has been the work of brilliant individuals of talent and passion, who have become some of the most respected and best remembered figures in nephrology. Unfortunately, we often forget that in many cases there were others, no less brilliant, whose vision and passion to study diseases of the kidney was no less intense but whose contributions have been forgotten. Francis Delafield (1841-1915) is one of those important but overlooked figures. An 1863 graduate of the College of Physicians and Surgeons, he continued his studies in London and Berlin, and upon his return to New York became a pioneer in histopathology in general and that of kidney disease in particular. He provided detailed and accurate microscopic descriptions of kidney pathology, made a concerted effort to correlate clinical signs and symptoms with kidney lesions and provided a nosological classification of the acute and chronic forms of what was then known merely as Bright's disease. During his life, he was recognized as the American authority on diseases of the kidney and the City of New York acknowledged his contributions by naming a hospital after him.

History, 19th Century↗
PubMedDate not supplied

A history of diabetes mellitus -- a disease of the kidneys that became a kidney disease.

Throughout most of its history, diabetes mellitus was considered, classified and promulgated as a disease of the kidneys. Recognized early in Antiquity by its excessive urine output, its clinical features and fatal outcome were recorded by the end of the first century A.D. by Areteus of Cappadocia and attributed to a weakness of the retentive ability of the kidneys by Galen. The saccharine character of the urine recognized from the sweetness of its taste in 1674 and that of the blood in 1774, was identified as due to glucose in 1815. Refinements in the measurement of glucose ascribed diabetes to increased blood sugar and early attempts at its dietary therapy, but the appearance of sugar in the urine continued to be attributed to the decreased retentive properties of the kidneys well into the middle of the 19th century. The experimental production of diabetes in pancreatectomized dogs in 1889, and ultimately the isolation of insulin in 1922, clearly established diabetes as an endocrine disease due to insulin deficiency that could be controlled by replacement therapy. The history of diabetes as a disease of the kidneys was now over. That of diabetes as a cause of kidney disease was launched shortly thereafter, in 1936.

Diabetes Mellitus↗