To examine recent scientific advances in our understanding of the pathophysiology of disorders of fluid, electrolytes, and acid-base balance.
To review how the understanding of pathophysiology can be applied to the care of patients.
To analyze how recent studies related to fluid, electrolyte, and acid-base disorders can be applied to clinical decision making.
It is the policy of American Society of Nephrology (ASN) that all individuals in a position to control the content of ASN's educational activities are expected to disclose all their and their life spouse/partner's financial relationships with “ineligible companies” within the prior 24 months as well as other non-financial interests. (“Ineligible companies” are those whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.) Participants should note that the use of products outside U.S. Food and Drug Administration (FDA) approved labeling should be considered experimental and are advised to consult current prescribing information for approval indications.
The intent of this policy is not to prevent expert faculty with relevant relationship(s) with commercial interest(s) from involvement in educational activities, but rather to ensure that these activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of control from commercial interests and free of commercial bias. In addition, all faculty were instructed to provide balanced, scientifically rigorous, and evidence-based presentations.
ASN requires all individuals in a position to control content for this activity to complete disclosure forms on the ASN website. Responses are listed below.
Disclosures have been reviewed and assessed by ASN. All relationships with ineligible companies have been identified and all relevant financial relationships have been mitigated.
Alice M. Sheridan, MD—Employer(s): Brigham and Women’s Hospital; No additional relevant financial relationship(s) with ineligible companies to disclose.
Martina M. McGrath, MBChB, FASN—Employer(s): Brigham and Women’s Hospital; VA Boston Medical Center; No additional relevant financial relationship(s) with ineligible companies to disclose.
Julian L. Seifter, MD—Employer(s): No additional relevant financial relationship(s) with ineligible companies to disclose.
Robert Jay Alpern, MD—Employer(s): Yale University School of Medicine; Ownership Interest: Abbott, AbbVie, Tricida, Apple, Berkshire Hathaway, IBM, Icahn Enterprises, Ford, Intel, Johnson and Johnson, Kraft Heinz, Merck, Pfizer, Verizon, Coca-Cola, UPS, Microsoft, Newell Brands, Organon, Peoples United Financial, Texas Pacific Land Corp, First Trust Nasdaq Bank, T. Rowe Price Real Estate Investor; Advisory/Leadership Role: Director of Abbott, AbbVie and Tricida. All are publicly traded for-profit; Other Interests/Relationships: Director of NewHYTES, a non-profit that uses tennis and education to help underprivileged children in New Haven.
Tushar Chopra, MD, FASN—Employer(s): University of Virginia Health System; Patents/Royalties: UpToDate
Thomas D. DuBose, Jr., MD, FASN—Employer(s): Wake Forest School of Medicine; No additional relevant financial relationship(s) with ineligible companies to disclose.
David H. Ellison, MD, FASN—Employer(s): Oregon Health & Science University, Portland VA Medical Center; Patents/Royalties: UpToDate
Namrata Krishnan, MD—Employer(s): Veterans Affairs Medical Center, West Haven, CT; Yale School of Medicine, New Haven, CT; Advisory/Leadership Role: Leadership roles within my institution, no outside paid roles; Other Interests/Relationships: NKF education committee, KSAP question writing committee.
Ruediger W. Lehrich, MD—Employer(s): Duke University Medical Center; No additional relevant financial relationship(s) with ineligible companies to disclose.
Martina M. McGrath, MBChB, FASN—Employer(s): Brigham and Women's Hospital, VA Boston Medical Center; Other Interests/Relationships: Deputy Editor, nephSAP; No additional relevant financial relationship(s) with ineligible companies to disclose.
Solomiia Savedchuk, MD—Employer(s): Duke University; No additional relevant financial relationship(s) with ineligible companies to disclose.
Zhabiz Solhjou, MD—Employer(s): Brigham and Women's Hospital; Patents/Royalties: Microneedle-Based Platform for Simultaneous Local Delivery of Drugs and Institial Skin Fluid Sampling for Management of Immune-Mediated Skin Diseases; Other Interests/Relationships: ASN member
Andrew S. Terker, MD, PhD—Employer(s): Vanderbilt University Medical Center; Consultancy: Andrew Terker consultancy fees by Ampio Pharmaceuticals; Ownership Interest: Ampio Pharmaceuticals
Joseph G. Verbalis, MD—Employer(s): Georgetown University; Consultancy: Corcept, EUSA, Otsuka; Honoraria: Corcept, EUSA, Otsuka ASN STAFF:
Suzanne P. Armstrong, MA—Employer(s): American Society of Nephrology; No additional relevant financial relationship(s) with ineligible companies to disclose.
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 10.0 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.
Original Release Date: January 2022
CME/MOC Termination Date: February 28, 2023
Examination Available Online: On or before January 30, 2022
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 March 2023, 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 eLEARNING CENTER (education.asn-online.org)
Select MY ACTIVITIES from the left-hand navigation.
Select the corresponding issue.
Read all information on the Overview screen.
Follow the onscreen instructions to:
Complete the Exam (i.e., post test),
Complete the Evaluation,
Claim credit/MOC, and
Print a Certificate
Your complete ASN Transcript is available on the ASN eLEARNING CENTER:
Select TRANSCRIPT on the left-hand navigation.
View course status, credits claimed, or print a certificate for completed learning activities.
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 firstname.lastname@example.org.