Brief Comment

The Unknown


As we know, 


There are known knowns. 


There are things we know we know. 


We also know 


There are known unknowns. 


That is to say 


We know there are some things 


We do not know. 


But there are also unknown unknowns, 


The ones we don't know 


We don't know.

Donald Rumsfeld, U.S. Secretary of Defense

—Feb. 12, 2002, Department of Defense news briefing

And looking through a nephrology lens…..

Some Known Knowns

Tubular transport in the kidney

Acid-base balance

Genetics of polycystic kidney disease

Podocyte biology

Many glomerulonephritides (post-infectious, anti-GBM, ANCA, lupus, etc)

Glomerular hemodynamics

Progression of renal disease

Iron metabolism

Use of hydration to prevent contrast nephropathy

Acute rejection
Frequency of dialysis, minimal dose of dialysis

Some Known Unknowns

Target hemoglobin in CKD patients
ESA therapy (dose) safety
Iron therapy safety

Optimal dose of dialysis

Optimal treatment time on dialysis

Slowing kidney progression

Role of sodium thiosulfate in calciphylaxis

Use of N-acetylcysteine to prevent contrast nephropathy

Use of sodium bicarbonate to prevent contrast nephropathy

Use of phosphate binders to reduce the risk of CVD in CKD patients

Role of protein restriction in slowing renal progression

Optimal blood pressure in CKD patients

Role of revascularization (angioplasty) in renal artery stenosis