From the Editor

EDITORIAL ADVISORY BOARD

Medical Director, Urology

Robert G. Uzzo, MD, MBA, FACS

G. Willing “Wing” Pepper Chair in Cancer Research Professor and Chairman Department of Surgery Fox Chase Cancer Center Temple University School of Medicine Philadelphia Urologists

Christopher S. Cooper, MD

Director, Pediatric Urology Children’s Hospital of Iowa Iowa City

R. John Honey, MD

Head, Division of Urology, Endourology/Kidney Stone Diseases St. Michael’s Hospital University of Toronto

Stanton Honig, MD

Department of Urology Yale University School of Medicine New Haven, CT

J. Stephen Jones, MD

Chief Executive Officer Inova Health System Falls Church, VA Professor and Horvitz/Miller Distinguished Chair in Urologic Oncology (ret.) Cleveland Clinic Lerner College of Medicine Cleveland

Jaime Landman, MD

Professor of Urology and Radiology Chairman, Department of Urology UC Irvine School of Medicine Orange, CA

James M. McKiernan, MD

John K. Lattimer Professor of Urology Chair, Department of Urology Director, Urologic Oncology Columbia University College of Physicians and Surgeons New York

Kenneth Pace, MD, MSc

Assistant Professor, Division of Urology St. Michael’s Hospital University of Toronto Vancouver, Canada Medical Director, Nephrology

Kamyar Kalantar-Zadeh, MD, PhD, MPH

Professor & Chief, Division of Nephrology, Hypertension & Kidney Transplantation UC Irvine School of Medicine Orange, CA

Nephrologists

Anthony J. Bleyer, MD, MS

Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, NC

David S. Goldfarb, MD

Professor, Department of Medicine Clinical Chief New York University Langone Medical Center Chief of Nephrology NY Harbor VA Medical Center

Csaba P. Kovesdy, MD

Chief of Nephrology Memphis VA Medical Center Fred Hatch Professor of Medicine University of Tennessee Health Science Center Memphis

Edgar V. Lerma, MD

Clinical Associate Professor of Medicine Section of Nephrology Department of Medicine University of Illinois at Chicago College of Medicine Chicago

Allen Nissenson, MD

Emeritus Professor of Medicine The David Geffen School of Medicine at UCLA Chief Medical Officer, DaVita Inc. Denver

Rulan Parekh, MD, MS

Associate Professor of Pediatrics and Medicine University of Toronto

Robert Provenzano, MD

Associate Professor of Medicine Wayne State University School of Medicine Detroit Vice President of Medical Affairs, DaVita Healthcare Denver

Robert S. Rigolosi, MD

Director, Regional Hemodialysis Center Holy Name Hospital Teaneck, NJ

Renal & Urology News Staff

Editor Jody A. Charnow Web editor Natasha Persaud Production editor Kim Daigneau Group creative director Jennifer Dvoretz Production manager Brian Wask Vice president, sales operations and production Louise Morrin Boyle Director of audience insights Paul Silver National accounts manager William Canning Editorial director, Haymarket Oncology Lauren Burke Vice president, content, medical communications Kathleen Walsh Tulley General manager, medical communications James Burke, RPh President, medical communications Michael Graziani Chairman & CEO, Haymarket Media Inc. Lee Maniscalco

FROM THE EDITOR

Urgency Again Propels Medical Advancement

In 1928, Dr Alexander Fleming, a Scottish physician and scientist, accidentally discovered a substance with antibacterial properties produced by a mold called Penicillium notatum. He called it penicillin. For more than a decade after Dr Fleming published his findings in the British Journal of Experimental Pathology in 1929, the discovery that would become one of the greatest medical advances of the 20th century met with little scientific interest.

Then World War II came along. Working with researchers from Oxford University in England who purified penicillin in 1939 and used it clinically for the first time in 1941, the United States — motivated to find a more effective treatment for wounds and illnesses in soldiers serving in the war — led a coordinated effort involving many scientists and multiple pharmaceutical companies to mass-produce penicillin.1,2 The effort brought penicillin out of the laboratory and into widespread clinical use, ushering in a new era in treating infectious diseases.

Nearly three-quarters of a century later, urgency once again provided an impetus to turn research into clinical reality. This time, rather than a war, the motivation is a pandemic. A desperate need for a vaccine to prevent infection with SARS-CoV-2, the novel coronavirus that causes COVID-19, catapulted messenger RNA (mRNA) vaccine technology from the laboratory into primetime. In less than a year, pharmaceutical companies Pfizer/BioNtech and Moderna, under contract with the US government as part of its “Operation Warp Speed,” translated investigational technology into COVID-19 mRNA vaccines and completed clinical trials that led to emergency use authorization from the Food and Drug Administration. A stunning achievement.

If mRNA vaccines bring an end to the pandemic and demonstrate long-term safety and efficacy, they may bring about a new era in infectious disease prevention. Researchers and pharmaceutical companies may be encouraged to develop mRNA vaccines to prevent many other illnesses, including those for which development of traditional vaccines has been elusive, such as HIV. With mRNA technology, vaccines can be produced more rapidly compared with conventional vaccines, which typically use weakened or killed pathogens to induce an immune response. In addition, because of the way mRNA vaccines work, there is no danger of recipients contracting the disease the vaccines are designed to prevent.

The COVID-19 virus likely will not be the last pathogen to cause a pandemic. If the COVID-19 mRNA vaccines fulfill their promise, governments and pharmaceutical companies will at least have a proven technology to address future emerging outbreaks.

Jody A. Charnow

Editor

1. Gaynes R. The discovery of penicillin—New insights after more than 75 years of clinical use. Emerg Infect Dis. 2017;23(5):849-853. doi:10.3201/eid2305.161556 2. Quinn R. Rethinking antibiotic research and development: World War II and the penicillin collaborative. Am J Public Health. 2013;103:426–434. doi:10.2105/AJPH.2012.300693

Contents

JANUARY/FEBRUARY 2021 ■ VOLUME 20, ISSUE NUMBER 1

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this month at renalandurologynews.com

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Nephrology

3 IgA Nephropathy in Patients with IBD Characterized Among patients with both diseases, the diagnosis of IBD occurs prior to IgAN onset, a study found.

4 Tacrolimus Shows Potential As Alternative MCNS Option Tacrolimus plus low-dose steroids vs highdose steroids alone achieve similar rates of complete remission, according to researchers.

7 Apixaban May Offer an Edge Over Warfarin Apixaban lowered the risk for CKD progression compared with warfarin in a study of CKD patients with nonvalvular atrial brillation.

7 Data Support Upfront RAS Inhibitors for Advanced CKD The likelihood of requiring kidney replacement therapy was lower compared with starting with a calcium channel blocker.

Urology

4 Testosterone May Reduce Diabetes Risk Testosterone therapy was associated with a 41% decreased risk for type 2 diabetes in a study of overweight and obese men.

5 RCC Surgery Postponement May Be Safe Delaying nephrectomy for clinically localized disease does not increase the risk of tumor progression, researchers reported.

6 Time to Say Goodbye to the DRE for Prostate Cancer Screening Justin Dubin, MD, and Sanoj Punnen, MD, MAS, of the University of Miami Miller School of Medicine, say the digital rectal examination adds little to decision making.

12 Uptake of Novel PCa Treatment Modalities Varies by Region Cost and differences in marketplace competition are among the reasons cited for geographic disparities in the use of innovative approaches.

For PCa screening ... we think [the digital

rectal examination] provides limited helpful information and potentially some risks. CALENDAR

Annual Dialysis Conference

Kansas City, Missouri March 5–7

National Kidney Foundation

Virtual Spring Clinical Meetings April 6–10

ERA-EDTA

Annual Congress Berlin, Germany June 5–8

Canadian Urological Association

Annual Meeting Niagara Falls, Ontario, Canada June 26–29

European Association of Urology

Annual Congress Milan, Italy July 9–13

American Urological Association

Annual Meeting Las Vegas, Nevada September 10–13

International Continence Society

Annual Meeting Melbourne, Australia October 12–15

15

Departments

1 From the Editor Urgency again propels medical advances.

3 News in Brief The FDA has approved the rst oral hormone therapy for advanced PCa.

15 Ethical Issues in Medicine How should healthcare providers decide who gets treated rst?

16 Practice Management Proposed HIPAA rule changes may facilitate patient access to their health information.