Keep Both ‘Renal’ and ‘Nephro’ in Glossary of Kidney Disease

“We call [on colleagues] to embrace the terms ‘kidney,’ ‘renal,’ and ‘nephro’ as they are used in different contexts and ask that scientific and medical journals not impose terminology restrictions,” urge the authors of a new commentary, published recently in the Journal of Nephrology.

They hope their words inspire more dialog about the nomenclature recommendations and glossary that arose from a June 2019 Kidney Disease Improving Global Outcomes (KDIGO) consensus conference, which was published in Kidney International and in about 20 nephrology and related medical journals, and which still generates controversy.

The report advises: “Use ‘kidney’ rather than ‘renal’ or ‘nephro’ when referring to kidney disease and kidney function,” commentary authors Kamyar Kalantar-Zadeh, MD, MPH, chief of nephrology, University of California Irvine Medical Center, in Orange, and colleagues write.

“Our point of view,” they continue, “is that ‘renal’ or ‘nephro’ should not be removed from scientific and technical writings. Instead, the terms can coexist and be used in their relevant contexts.”

For example, cardiologists use “heart” and “cardio” as needed (for example, “heart failure” and “cardiac care units”) and they have not replaced “cardiovascular disease” with “heart vessel disease” in journal articles.

In the same way, “chronic kidney disease” should coexist with “continuous renal replacement therapy”, the commentary authors maintain.

The KDIGO consensus meeting was attended by mainly editors from multiple nephrology and related journals, plus a few researchers and patient-support group representatives.

They based their recommendations on replies to a survey they answered prior to the meeting, as well as data from 10 focus groups of 54 adults with chronic kidney disease and 13 caregivers in the United States, United Kingdom, and Australia.

“Kidney” Is Useful to Communicate Clearly With Patients

The authors of the commentary commend the report authors for striving to make the nomenclature glossary “patient-centered,” but they also have some reservations about it.

“We support the decade-old move to use ‘kidney’ more frequently than ‘renal’ or ‘nephron’, especially in communications with patients and nonmedical persons,” Kalantar-Zadeh and coauthors write.

“In English-speaking countries, when communicating with patients and with the public-at-large, we should use the word ‘kidney’,” they agree. For example, World Kidney Day has emerged as a successful way to raise awareness about kidney disease.

However, in some non-English-speaking countries, patients are familiar with the term ‘nephro’ (derived from the Greek word nephros meaning kidney) or ‘renal’ (derived from Latin [ren]), which is very similar to the words for kidney in French (rein), Italian (rene), and Spanish (rinon).   

But “Renal” and “Nephro” Should Not Be Purged From Journal Articles

But the main objection that the commentary authors have with the nomenclature report is they strongly feel that “renal” or “nephro” should not be vehemently removed from scientific and technical writings, and medical journals should not force authors to do so as a requirement for publication.

“Renal” and “nephro” are widely used and have precise meanings, they say. They are used in more than 70 disease names in the International Classification of Diseases (ICD), in the titles of 32 peer-reviewed journals related to kidney disease, in patient support group names, and in many nephrology societies, clinics, and hospital departments.

“While changing everything to kidney is do-able,” they concede, “it will not produce the ideal outcome that has been proposed. It would be similar to saying that only the word ‘red’ can be used when the words ‘vermilion,’ ‘rose,’ ‘scarlet,’ and others make our language come alive and actually convey something slightly different than just the term ‘red’.”

“Among professionals and for scientific and health policy writings, ‘renal’ and ‘nephro’ are appropriate means of communication, while for most public and patient advocacy, kidney may be a better choice,” the commentary authors summarize.

Kalantar-Zadeh has reported receiving commercial honoraria and/or support from Abbott, AbbVie, Akebia, Alexion, Amgen, Ardelyx, AstraZeneca, Aveo, Chugai, DaVita, Fresenius Kabi, Genentech, Haymarket Media, Hospira, Keryx, Novartis, Pfizer, Relypsa, Resverlogix, Sandoz, Sanofi, Shire, Vifor, UpToDate, and ZS Pharma.

J Nephrol. Published online March 13, 2021. Abstract

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