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.
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.
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
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
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.
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
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.
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
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.
Instructions to obtain American Board of Internal Medicine (ABIM) Maintenance of Certiﬁcation (MOC) Points
Each issue of nephSAP provides 10 MOC points. Respondents must meet the following criteria:
Be certiﬁed by ABIM in internal medicine and/or nephrology and enrolled in the ABIM–MOC program...
Enter your (ABIM) Candidate Number and Date of Birth prior to completing the examination.
Take the self-assessment examination within the timeframe speciﬁed in this issue of nephSAP.
Upon completion, click Claim Your MOC points, the MOC points submitted will match your CME credits claimed, check the Attestation Statement box and submit.
ABIM will notify you when MOC points have been added to your record.
ABIM MOC Statement
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10.0 MOC points 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 Joint Accreditation 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.
System Requirements Compatible Browser and Software
The nephSAP website (nephsap.org) is formatted for cross-browser functionality, and should display correctly in all currently supported web browsers. Individual nephSAP articles are available as dynamic HTML or in Portable Document Format (PDF), which requires Adobe Reader or comparable PDF viewing software.
The nephSAP website is designed for responsive display. This means the content display will respond to the device you use and to your devices screen resolution.
Medium or Combination of Media Used
The media used include content provided online as dynamic HTML or downloadable PDF, in addition to an online evaluation and self-assessment examination.
If you have difficulty viewing any of the pages, please refer to the nephSAP technical support page for possible solutions. If you continue having problems, contact ASN at email@example.com.