Inequality and the Chinese elite: Between international convergence and national divergence.

This paper considers the position of the Chinese elite in both national and international contexts. I show that the Chinese elite has converged with the global elite in terms of their incomes, and that many senior Chinese executives are at least as well paid as their counterparts in rich countries. Their insertion into the global elite is further demonstrated by their increasing participation in the World Economic Forum. But this international convergence has been mirrored by national divergence: economic inequality has risen within China, extending the distance between elites and the rest of the population. I show that for top income groups, the relative cost of employing a median wage worker for their personal service has plummeted, increasing their entitlements over labor and thus their capacity to dominate their compatriots. This has been accompanied by a dramatic rise in the reliance of the elite on domestic workers, a traditional symbol of social inequality. Thus the convergence of Chinese elites with their international counterparts has gone hand in hand with both rising economic inequality and rising social inequality within China.

Point-of-care ultrasound education to improve care of dialysis patients.

Point-of-care ultrasound (POCUS) is rapidly emerging as a bedside diagnostic tool that can enhance physical diagnosis and facilitate clinical decision making. Although ultrasound is widely used by nephrologists for vascular access and kidney imaging, diagnostic POCUS skills in other anatomic areas are not part of routine nephrology training. In this narrative review, we will provide an overview of selected POCUS techniques, highlight potential uses of POCUS in routine nephrology practice, and describe a new curriculum implemented at Johns Hopkins University School of Medicine to teach diagnostic POCUS skills to nephrology fellows.

Antineutrophil cytoplasmic antibody vasculitis associated with influenza vaccination.

BACKGROUND: Administration of influenza vaccines has been associated with the development of autoantibodies and autoimmune rheumatic disease. PATIENTS: We discuss 2 patients who developed antineutrophil cytoplasmic antibody-associated vasculitis (AAV) in temporal association with influenza immunization. AAV was diagnosed 2 and 4 weeks after immunization in these patients. Both patients had renal involvement with one requiring dialysis. Both patients were treated with cyclophosphamide and corticosteroids, and plasmapheresis was added to the immunosuppressive regimen in one patient with dialysis-dependent renal failure. Both patients achieved disease remission. The patient with initial dialysis-dependent renal failure reached end-stage renal disease. There are 6 previous cases of AAV in the literature described in temporal association with administration of influenza vaccines. CONCLUSION: A causal role of vaccines in AAV cannot be confirmed with these case reports. The temporality suggests that the influenza vaccine may be a triggering factor for induction of vasculitis in predisposed individuals. We review the literature on reported cases of AAV following influenza vaccine administration and discuss possible mechanisms for influenza vaccine-associated AAV.

Recent advances and prognosis in idiopathic membranous nephropathy.

Idiopathic membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome. Recently, progress has been made in understanding the pathogenesis of idiopathic MN with the finding of M-type phospholipase A2 receptor (PLA2R) antibodies in the serum and immune complexes of glomeruli in the majority of adult idiopathic MN patients. In the future, the detection of M-type PLA2R antibodies may help distinguish patients with primary MN who require aggressive immunosuppressive therapy from those with secondary disease. Levels of circulating antibody to this receptor may help in monitoring disease activity and in gauging response to therapy, as changes in antibody levels may precede changes in proteinuria. The degree of renal dysfunction or change in renal function over time and the level of persistent proteinuria are key prognostic factors in the decision to initiate therapy in idiopathic MN patients. Although spontaneous remissions occur in ~30% of patients, partial and complete remissions help to define the clinical course of an individual patient.