Myths and Shibboleths in Nephrology

Myths and Shibboleths.- 1. Urinary tract infection can lead to end stage renal disease (ESRD).- 2. Kidney donation does not jeopardize function in the remaining kidney.- 3. Hypertension imposes a risk of chronic kidney failure.- 4. Angiotensin converting enzyme inhibitors (ACEi) are superior to other antihypertensive drugs because of their renoprotective properties.- 5. Dietary protein restriction slows progression of renal insufficiency.- 6. Plasmapheresis is beneficial in some renal disorders.- 7. Urinary tract infection is more prevalent in diabetes.- 8. Type 1 diabetes is more likely than type 2 diabetes to lead to nephropathy and ESRD.- 9. Pharmacological strategies may prevent acute tubular necrosis (ATN).- 10. Intravenous iron may be hazardous in infected hemodialysis patients.- 11. Peritoneal dialysis is equivalent to hemodialysis.- 12. Rationing of ESRD treatment is an unavoidable reality.- 13. Tacrolimus is superior to cyclosporine in renal transplantation.- 14. Dialyzer re-use is safe and cost effective.- 15. Living related pancreas after kidney transplantation is preferable to cadaveric simultaneous pancreas-kidney transplantation.- 16. Administration of active vitamin D metabolites is beneficial in patients with advanced chronic renal failure (pre end-stage renal disease).- 17. Surgical intervention and prompt nephrectomy are preferred in emphysematous pyelonephritis.- 18. Mortality in chronic hemodialysis is greater in the U.S. than in Europe and Japan.- 19. A single hemodialysis treatment prevents uremic bleeding and restores platelet function.- 20. Kidney biopsy is indicated in every case of lupus nephritis.- 21. Indicators of glycemic control in diabetic ESRD patients should be equivalent to those utilized in earlier stages of diabetic nephropathy.- 22.Fish oil is effective therapy for IgA nephropathy.- 23. Physician assistants should replace nephrologists in dialysis units.- 24. Patients with severe cerebrovascular accidents (CVA) require long-term bladder catheters.- 25. Pre-transplant blood transfusions enhance renal allograft survival.- 26. Hemoperfusion is superior to hemodialysis in the treatment of certain poisonings and/or drug overdoses.- Epilogue.