Learning Objectives

• To discuss recent developments in the diagnosis, monitoring, and therapy of CKD -mineral and bone disorder.
• To describe new developments in calcium and phosphate physiology and pathophysiology, with updates on recent information regarding derangements of mineral metabolism in normal and decreased kidney function.
• To explain bone disease including osteoporosis and renal osteodystrophy.
• To summarize new information regarding disorders of magnesium, calcium, and vitamin D metabolism, including primary hyperparathyroidism.
• To examine recent updates in the causes, diagnosis, and therapy of hypercalcemia.
• To review recent advances in kidney stone disease.

Disclosure Information

ASN is responsible for identifying and resolving all conflicts of interest prior to presenting any educational activity to learners to ensure that ASN CME activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of the control from commercial interests and free of bias. All faculty are instructed to provide balanced, scientifically rigorous and evidence-based presentations. In accordance with the disclosure policies of the Accreditation Council for Continuing Medical Education (ACCME), individuals who are in a position to control the content of an educational activity are required to disclose relationships with a commercial interest if (a) the relation is financial and occurred within the past 12 months; and (b) the individual had the opportunity to affect the content of continuing medical education with regard to that commercial interest. For this purpose, ASN consider the relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Peer reviewers are asked to abstain from reviewing topics if they have a conflict of interest. Disclosure information is made available to learners prior to the start of any ASN educational activity.

EDITORS:

Alice M. Sheridan, MD—Current Employer: Brigham and Women’s Hospital

Martina M. McGrath, MBChB, FASN—Current Employer: Brigham and Women’s Hospital; VA Boston Medical Center

EDITORAL AUTHOR:

Marc G. Vervloet, MD, PhD—Current Employer: Amsterdam University Medical Center; Consultancy Agreements: Amgen, Otsuka, Vifor-Fresenius Medical Care Renal Pharma, Kyowa Kirin, Medice; Research Funding: Fresenius Medical Care, Amgen, Vifor, NedMag; Honoraria: Shire, Amgen, Astra Zeneca, Baxter, Fresenius Medical Care, Otsuka, Kissei, Kyowa kirin, VFMCRP; Scientific Advisor or Membership: Chair ERA-EDTA working group on CKD-MBD, Workgroup member KDIGO CKD-MBD, Scientific board Dutch Kidney Foundation, Editorial Board Nephrol Dial Transplant

AUTHORS:

Deepak K Agarwal, MD—Current Employer: Indiana University

Matthew J. Damasiewicz, MBBS—Current Employer: Monash Medical Centre

Grahame Elder, MBBS, PhD—Current Employer: Western Sydney Local Health District; Research Funding: Amgen Australia; Honoraria: Sanofi Aventis Australia, Shire Australia; Scientific Advisor or Membership: Advisory Committee Membership, Sanofi Aventis Australia

Amy E. Krambeck, MD—Current Employer: Northwestern University Medical Group; Consultancy Agreements: Boston Scientific, Lumenis, Sonomotion, Dornier, Virtuoso; Research Funding: Boston Scientific, Lumenis; Honoraria: Lumenis, Boston Scientific, Dornier; Patents and Inventions: B7H1 and Survivin as a marker for Renal Cell Carcinoma; Scientific Advisor or Membership: Boston Scientific

Rosa M.A. Moys´es, MD, PhD—Current Employer: Nephrology Division, Universidade de Sao Paulo; Other Interests/Relationships: Departamento de Metabolismo Mineral da Sociedade Brasileira de Nefrologia

Thomas L. Nickolas, MD, MS—Current Employer: Columbia University; Research Funding: Amgen; Patents and Inventions: Columbia University has licensed patents on NGAL to Abbott Diagnostics and Alere; Scientific Advisor or Membership: Amgen

Sagar U. Nigwekar, MD—Current Employer: Massachusetts General Hospital; Consultancy Agreements: Becker Professional Education, Allena Pharma, Epizon Pharma, Laboratoris Sanifit; Ownership Interest: Becker Professional Education, Allena Pharma, Epizon Pharma, Laboratoris Sanifit; Research Funding: Hope Pharma; Allena Pharma; Laboratoris Sanifit, Inozyme Pharma; Honoraria: Sanofi-Aventis; Guidpoint; Scientific Advisor or Membership: Vifor pharma, Ardelyx

Susan M. Ott, MD—Current Employer: University of Washington Medical Center; Other Interests/Relationships: UptoDate (reviewer)

Jason R. Stubbs, MD—Current Employer: University of Kansas Medical Center; Consultancy Agreements: Novadiol; Research Funding: Genzyme; ScientificAdvisor or Membership: Spectradyne LLC

Silvia M. Titan, MD, PhD—Current Employer: Tufts Medical Center

Carsten A. Wagner, MD—Current Employer: University of Zurich; Consultancy Agreements: Ardelyx, Bayer; Medice; Research Funding: Bayer, Chugai; Honoraria: Bayer, Medice, Kyowa Kirin, Scientific Advisor or Membership: ERA-EDTA Scientific Advisory Board; Other Interests/Relationships: Co-chair ERAEDTA, Scientific Advisory Board

James B. Wetmore, MD, MS—Current Employer: Hennepin County Medical Center; Consultancy Agreements: Ad hoc consulting for BMS-Pfizer Alliance; Research Funding: AstraZeneca, OPKO Health, Merck, Genentech, Amgen, BMS/Pfizer; Honoraria: BMS-Pfizer Alliance (for advisory board activities, as noted below); Scientific Advisor or Membership: BMS-Pfizer Alliance: No standing relationships, but I participate on occasion on ad hoc advisory boards.

Commercial Support

There is no commercial support for this issue.

The nephSAP editorial team and the KSAP editorial board extend their sincere appreciation to the following reviewers. Their efforts and insights help improve the quality of these postgraduate education offerings.

nephSAP Review Panel

• Mustafa Ahmad, MD, FASN, King Fahad Medical City, Riyadh, Saudi Arabia
• Jafar Al-Said, MD, FASN, Bahrain Specialist Hospital, Manama, Bahrain
• Carmichael Angeles, MD, FASN, Pharmaceutical Product Development, Wilmington, NC
• Kisra Anis, MBBS, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
• Naheed Ansari, MD, FASN, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
• Nabeel Aslam, MD, FASN, Mayo Clinic Florida, Jacksonville, FL
• Nisha Bansal, MD, University of Washington, Tulsa, OK
• Krishna M. Baradhi, MD, University of Oklahoma, Tulsa, OK
• Emmy Bell, MD, MSPH, University of Alabama at Birmingham, Birmingham, AL
• Bruce E. Berger, MD, Case Western Reserve University, Cleveland, OH
• Mona B. Brake, MD, Robert J. Dole Veteran Affairs Medical Center, Wichita, KS
• Pooja Budhiraja, MBBS, University of Kansas Medical Center, Kansas City, KS
• Ruth C. Campbell, MD, Medical University of South Carolina, Charleston, SC
• Chia-Ter Chao, MD, National Taiwan University Hospital, Taipei, Taiwan
• Chokchai Chareandee, MD, FASN, University of Minnesota, Minneapolis, MN
• Joline L. Chen, MD, Long Beach Veteran Affairs Healthcare System, Orange, CA
• Karen Ching, MD, Hawaii Permanente Medical Group, Honolulu, HI
• W. James Chon, MD, University of Arkansas for Medical Sciences, Little Rock, AR
• Jason Cobb, MD, Emory University School of Medicine, Atlanta, GA
• Armando Coca, MD, PhD, Hospital Clínico Universitario, Valladolid, Spain
• Scott D. Cohen, MD, FASN, George Washington University, Washington, DC
• Beatrice Concepcion, MD,Vanderbilt University Medical Center, Nashville, TN
• Gabriel Contreras, MD, University of Miami, Miami, FL
• Patrick Cunningham, MD, University of Chicago, Chicago, IL
• Kevin A. Curran, MD, Kevin A. Curran, MD, Canton, TX
• Rajiv Dhamija, MD, Rancho Los Amigos National Rehabilitation Center, Downey, CA
• Alejandro Diez, MD, The Ohio State University, Columbus, OH
• John J. Doran, MD, Emory School of Medicine, Atlanta, GA
• Randa A. El Husseini, MD, FASN, HealthPartners Medical Group, St. Paul, MN
• Pedram Fatehi, MD, Stanford Medicine, Palo Alto, CA
• William H. Fissell, MD, Vanderbilt University Medical Center, Nashville, TN
• D. Kevin Flood, MD, Mike O’Callaghan Federal Medical Center, Nellis AFB, NV
• Lynda A. Frassetto, MD, FASN, University of California at San Francisco, San Francisco, CA
• Tibor Fulop, MD, University of Mississippi Medical Center, Jackson, MS
• Maurizio Gallieni, MD, FASN, University of Milano, Milano, Italy
• Duvuru Geetha, MD, FASN, Johns Hopkins University, Baltimore, MD
• Ilya Glezerman, MD, Memorial Sloan Kettering Cancer Center, New York, NY
• Carl S. Goldstein, MD, FASN, Rutgers University, New Brunswick, NJ
• Basu Gopal, MBBS, FASN, Royal Adelaide Hospital, Adelaide, Australia
• Steven Gorbatkin, MD, PhD, Emory University and Atlanta Veteran Affairs Medical Center, Decatur, GA
• Aditi Gupta, MD, University of Kansas Medical Center, Kansas City, KS
• Susan Hedayati, MD, University of Texas Southwestern, Dallas, TX
• Marie C. Hogan, MBBCh, PhD, Mayo Clinic, Rochester, MN
• Susie Hu, MD, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
• Edmund Huang, MD, University of California at Los Angeles School of Medicine, Los Angeles, CA
• Ekambaram Ilamathi, MD, FASN, Northwell Health, Southside Hospital, Bayshore, NY
• Talha Imam, MD, Kaiser Permanente, Fontana, CA
• Joshua M. Kaplan, MD, Rutgers New Jersey Medical School, Newark, NJ
• Amir Kazory, MD, University of Florida, Gainesville, FL
• Quresh T. Khairullah, MD, St. Clair Nephrology, Roseville, MI
• Apurv Khanna, MD, State University of New York Upstate Medical University, Syracuse, NY
• Yong-Lim Kim, MD, PhD, Kyungpook National University Hospital, Daegu, South Korea
• Nitin V. Kolhe, MD, FASN, Derby Teaching Hospital NHS Trust Derby, Derbyshire, UK
• Farrukh M. Koraishy, MD, PhD, St. Louis University, St. Louis, MO
• Eugene C. Kovalik, MD, Duke University Medical Center, Durham, NC
• Steven Kraft, MD, Western Nephrology, Lafayette, CO
• Vineeta Kumar, MD, University of Alabama at Birmingham, Birmingham, AL
• Sarat Kuppachi, MD, University of Iowa, Iowa City, IA
• Norbert H. Lameire, MD, PhD, Gent, University Hospital, East Flanders, Belgium
• Sheron Latcha, MD, Memorial Sloan Kettering Cancer Center, New York, NY
• Vincent Weng Seng Lee, MBBS, PhD, Westmead Hospital, Sydney, NSW Australia
• Paolo Lentini, MD, PhD, St. Bortolo Hospital, Bassano del Grappa, Italy
• Oliver Lenz, MD, University of Miami Health System, Miami, FL
• Tingting Li, MD, Washington University in St. Louis, St. Louis, MO
• Orfeas Liangos, MD, FASN, Klinikum Coburg, Coburg, Bayern, Germany
• Michael Lioudis, MD, Cleveland Clinic Nephrology, Cleveland, OH
• Ajit Mahapatra, MD, The Permanente Medical Group, Santa Clara, CA
• A. Bilal Malik, MBBS, University of Washington, Seattle, WA
• Jolanta Malyszko, MD, PhD, Medical University, Bialystok, Poland
• Ernest Mandel, MD, Brigham and Women’s Hospital, Boston, MA
• Naveed N. Masani, MD, Winthrop University Hospital, Mineola, NY
• Teri Jo Mauch, MD, PhD, University of Nebraska College of Medicine Omaha, NE
• Hanna W. Mawad, MD, FASN, University of Kentucky, Lexington, KY
• Ellen T. McCarthy, MD, University of Kansas Medical Center, Kidney Institute, Kansas City, KS
• Kirtida Mistry, MBBCh, Children’s National Medical Center, Washington, DC
• Lawrence S. Moffatt, MD, Carolinas Medical Center, Charlotte, NC
• David B. Mount, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
• Thangamani Muthukumar, MD, Weill Cornell Medicine, New York, NY
• Mohanram Narayanan, MD, Baylor Scott & White Health, Temple, TX
• Macaulay A. Onuigbo, MD, Mayo Clinic, Rochester, MN
• Rosemary Ouseph, MD, St. Louis University, Webster Groves, MO
• Todd Pesavento, MD, Ohio State University, Columbus, OH
• Phuong-Thu Pham, MD, David Geffen School of Medicine at UCLA, Los Angeles, CA
• Pairach Pintavorn, MD, FASN, East Georgia Kidney and Hypertension, Augusta, GA
• Roberto Pisoni, MD, Medical University of South Carolina, Charleston, SC
• James M. Pritsiolas, MD, FASN, CarePoint Health - Bayonne Medical Center, Bayonne, NJ
• Paul H. Pronovost, MD, FASN, Yale University School of Medicine, Waterbury, CT
• Mohammad A. Quasem, MD, FASN, State University of New York Medical University, Binghamton, NY
• Wajeh Y. Qunibi, MD, University of Texas Health Science Center, San Antonio, TX
• Pawan K. Rao, MD, FASN, St. Joseph’s Hospital and Health Center, Syracuse, NY
• Hernan Rincon-Choles, MD, Cleveland Clinic Foundation, Cleveland, OH
• Dario Roccatello, MD, San Giovanni Hospital and University of Torino, Torino, Italy
• Helbert Rondon-Berrios, MD, FASN, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Ehab R. Saad, MD, FASN, Medical College of Wisconsin, Milwaukee, WI
• Mark C. Saddler, MBChB, Mercy Regional Medical Center, Durango, CO
• Neil Sanghani, MD, Vanderbilt University, Nashville, TN
• Mohammad N. Saqib, MD, Lehigh Valley Hospital, Allentown, PA
• Hitesh H. Shah, MD, Hofstra Northwell School of Medicine, Great Neck, NY
• Michiko Shimada, MD, PhD, Hirosaki University, Hirosaki, Japan
• Shayan Shirazian, MD, Winthrop-University Hospital State University of New York at Stony Brook, Mineola, NY
• Arif Showkat, MD, FASN, University of Tennessee, Memphis, TN
• Stephen M. Sozio, MD, Johns Hopkins University School of Medicine, Baltimore, MD
• Ignatius Yun-Sang Tang, MD, FASN, University of Illinois at Chicago, Chicago, IL
• Ahmad R. Tarakji, MD, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
• Hung-Bin Tsai, MD, National Taiwan University, Taipei, Taiwan
• Katherine Twombley, MD, Medical University of South Carolina, Charleston, SC
• Kausik Umanath, MD, Henry Ford Hospital, Detroit, MI
• Puchimada M. Uthappa, MBBS, FASN, Columbia Asia Hospital, Mysore, Karnataka, India
• Anthony M. Valeri, MD, Columbia University Medical Center, New York, NY
• Allen W. Vander, MD, FASN, Kidney Center of South Louisiana, Thibodaux, LA
• Jon R. Von Visger, MD, PhD, The Ohio State University, Columbus, OH
• Nand K. Wadhwa, MD, Stony Brook University, Stony Brook, NY
• Connie Wang, MD, Hennepin County Medical Center, Minneapolis, MN
• Maura A. Watson, DO, Walter Reed National Military Medical Center, Bethesda, MD
• Dawn Wolfgram, MD, Medical College of Wisconsin, Milwaukee, WI
• Sri Yarlagadda, MBBS, University of Kansas Medical Center, Kansas City, KS
• Brian Young, MD, Santa Clara Valley Medical Center, San Jose, CA
• Mario Javier Zarama, MD, Kidney Specialists of Minnesota, Saint Paul, MN

Program Mission and Objectives

nephSAP® provides a learning vehicle for physicians, scientists, advanced practitioners, nurses, pharmacists, and other health professionals working and training in the field of nephrology to renew and refresh their clinical knowledge, diagnostic, and therapeutic skills. This enduring material provides learners challenging, clinically-oriented questions based on case vignettes, detailed learning objectives, a series of articles that review recent publications, and an editorial on an important and evolving topic. This combination of materials enables learners to rigorously assess their strengths and weaknesses in the broad domain of nephrology.

Target Audience

Physicians, scientists, advanced practitioners, nurses, pharmacists, and other health professionals working and training in the field of nephrology.

Accreditation and AMA Credit Designation Statements

In support of improving patient care, the American Society of Nephrology is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

The American Society of Nephrology designates this internet activity (enduring material) for a maximum of 10.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC Statement

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10.0MOCpoints in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. MOC points will be applied to only those ABIM candidates who have enrolled in the MOC program. It is your responsibility to complete the ABIM MOC enrollment process.

Original Release Date: December 2020

CME/MOC Termination Date: November 30, 2022

Examination Available Online: On or before December 31, 2020

Estimated Time for Completion: 10 hours 

Self-Assessment Examination

• Answers with explanations are provided with a passing score after the first and/or second attempt
• This issue will be archived in December 2022, and answers with explanations will be posted on the ASN website

Method of Participation

• Read the entire issue that is supplemented by original articles in the reference lists.
• Complete the online self-assessment examination.
• Each participant is allowed two attempts to pass the examination (75% correct) for CME and MOC.
• Upon completion, review your score and incorrect answers and print your certificate.

Activity Evaluation, CME and MOC

• Go to ASN CME Center (www.asn-online.org/cme), and log in.
• Click the ENTER ACTIVITY button for this issue.
• Read all frontmatter information.
• Under the To Do List on the left navigation:
  • Click the Demographics & General Eval link, and enter your information.
  • If you are a physician:
    • Complete the Exam (required for CME/MOC). Physicians participating in this activity will be given two (2) attempts to pass the Exam (minimum performance level = 75% correct). Upon completion, you wil be able to access the Answers and Explanations for viewing. If you do not pass the Post Test within 2 attempts, you cannot claim CME/MOC for this activity.
    • Click the Claim Your CME Credits link, check the Attestation Statement box, and submit.
    • Click the Claim Your MOC Points link (for ABIM Diplomates only), check the Attestation Statement box, and submit.
• Click the Print Your Certificate link.

For your complete ASN transcript, click the ASN CME Center banner, and click View/Print Transcript on the left.