The pre-classes at Kidney Week have appeared to be a constant. Every year there is critical care nephrology class, an electrolyte and acid-base master class, a glomerulonephritis series, a maintenance hemodialysis class, and a maintenance of certification series. I have taken them all and they are all excellent. This year while I was perusing the catalog, a new title popped up: Women’s Renal Health Across the Decades. It sounded like a history class on nephrology’s treatment of women. Interesting. Rather than doing a re-run of a classic pre-class, I signed up.
Turns out, it was not a history class. The “across the decades” did not refer to the 70s, 80s, and 90s but rather stages of life: fetal life, pediatrics, adolescence, child bearing age, and menopause.
The content was broad and deep. While it covered the obvious and important issues of renal disease in pregnancy, it also included many areas I had never thought about: menopause, fertility in renal disease, implications of fetal development on adult renal function, and the long-term renal implications of preeclampsia, among others.
In some ways, the Women’s Renal Health pre-course fulfiulls an important hole that only an ASN pre-course could fulfill. Every medical center and fellowship program has at least one electrolyte guru, more than one expert on glomerular disease and lupus, a few people that thrive in the ICU and with AKI. So a dedicated fellow or interested nephrologist always has someone to go to for a complex case, a second opinion, or just some intellectual back-up. But most fellowships are missing an expert on women’s health in kidney disease. Who do you go to ask questions about the premature amenorrhea of ESRD? Where do you get a second opinion on the differentiation of acute fatty liver of pregnancy from HELLP? This is where this class excels. Michelle Hladunewich and Belinda Jim brought together an all-star cast of world experts to discuss a comprehensive slate of renal issues in women health.
Michelle Hladunewich explained that too many issues of pregnancy get ignored in CKD. The conversation begins with, “pregnancy is risky in CKD” and unfortunately doesn’t progress beyond this. Despite the increased risk, women with CKD often still want to have children and nephrologists need to have more sophisticated knowledge beyond “pregnancy is risky in CKD.” When is the optimal time for pregnancy. At what GFR is it better to delay pregnancy until after a kidney transplant? What defines stability in lupus, such that a patient can pursue pregnancy? Dr. Hladunewich talked about the “pregnancy wish” that is so important to some woman. We need effective and comprehensive training on all of these issues and more. Some of the most valuable parts of the course were on the issues of amenorrhea and pre-mature menopause in ESRD. This is an issue that I had no knowledge on and had never even seen a class about it.
The whole pre-class was great, and despite the sparse audience it is something that the ASN needs to continue because there is simply no other avenue for this information to be delivered.
Post by Dr. Joel Topf, AJKD Blog Advisory Board member.
Check out all of AJKD Blog’s coverage of Kidney Week 2015!