July 30, 2026 Update — Clinical Mastery expansion, 32 student handouts, and navigation recovery
A new physician-level Clinical Mastery review covering three drug families that reach the hypertension and kidney clinic constantly and are rarely considered together: antidepressants, anxiolytics, and ADHD medications. The organizing idea is that blood-pressure effect tracks norepinephrine transporter blockade rather than the marketing category — which is why “non-stimulant” ADHD agents are not blood-pressure safe, and why guanfacine lowers adult systolic pressure by roughly 10 mmHg.
Practical content includes the antihypertensive interactions worth avoiding outright (paroxetine and fluoxetine raise metoprolol exposure three- to five-fold; diltiazem raises buspirone exposure 5.5-fold), bupropion’s metabolite trap in dialysis where the parent drug looks reassuringly normal, serotonin syndrome with the Hunter criteria and its rhabdomyolysis consequence, and renal dosing tables for both drug families. The review states plainly where the evidence is thin — there are no ADHD pharmacotherapy studies in CKD populations, and the randomized antidepressant trials in CKD are negative or modest.
The material ships at three depths, so the same evidence reaches a student revising for an exam, a classroom, and a clinician making a prescribing decision:
Four new interactive cases bring the case library from 30 to 34. Each is built around a decision point where the intuitive answer is the wrong one, and each is cross-linked from all three pages above:
A full audit compared every clinical section of this site against the source material behind it. The finding was not that content was missing. It was that a great deal of finished work had never become reachable — written, and then left where no reader could get to it. Today closed most of that gap.
A new lecture, Acute Interstitial Nephritis, joins the AKI module with the complete etiologic taxonomy — every implicated drug class with its characteristic latency, infectious and systemic causes, malignancy, and the genetic tubulointerstitial diseases — and sorts treatment by etiology, with an explicit “do NOT” column for each. It introduces a provenance convention: each substantive claim is tagged EVIDENCE-BASED (anchored to a named study with a PMID) or PRACTICE-BASED (standard teaching, not trial-anchored). AIN has very little randomized evidence, and blurring that line does readers no favors. A companion physician-level review, AIN: Complete Etiology and Etiology-Directed Treatment, carries the same tagging across 31 verified references.
The correction. Building it surfaced an error on an existing page: the positive likelihood ratio for urine eosinophils was given as 1.83. Checked against the source (Muriithi, CJASN 2013), the correct value is 0.97, and the negative likelihood ratio is 1.01. Both sit at 1.0 — the test moves post-test probability essentially nowhere in either direction. Specificity was corrected from 85% to 68.2%, and “when present, highly suggestive” was removed, since the positive predictive value is 15.6% and most positives are false. Seven pages in total carried some version of the old claim, including two Primer chapters and two handouts; all seven now agree. The bottom line is unchanged but now correctly supported: do not order urine eosinophils.
The Case Report Library — eight long-form teaching cases, roughly 46,000 words — had no inbound link from any page on this site. It is now on the homepage. Two Clinical Mastery modules were missing from the catalog entirely: Advanced Electrolytes, the largest module in the series, and Paraprotein-Related Kidney Disease. Edema & Diuretic Therapy had been unreachable since March. The Mercy Family Practice Residency CKD series is now linked from the case index.
Thirty-two finished handouts are published for the first time, each with a downloadable PDF. Most were written back in February and then sat unpublished because the build that generates handout pages read one vault folder and they had been filed in another. New material spans AKI (staging, ATN, BMP pattern recognition), electrolytes and acid-base (RTA, integrated calcium physiology, phosphorus), glomerular disease (ANCA vasculitis, membranous nephropathy, post-infectious GN, and diagnostic algorithms for glomerular disease and RPGN), CKD (staging, CKD-MBD, anemia, management pathways), dialysis (CRRT, peritoneal dialysis, initiation, vascular access, kinetics and adequacy), pharmacology (drug dosing in CKD, SGLT2 inhibitors), foundations (the BMP and urinalysis master algorithms), and transplant, edema, hypertension, and onconephrology.
Twelve physician-level reviews moved from draft to published. Hypertension gains the newest drug classes — baxdrostat and lorundrostat, the two aldosterone synthase inhibitors, plus aprocitentan, a genuinely new mechanism for resistant hypertension — and acute renal infarction, a diagnosis routinely mistaken for renal colic. Dialysis gains CRRT principles, partial (incremental) PD, and screening and health maintenance on maintenance hemodialysis. CKD gains albuminuria versus proteinuria measurement and phosphate management in ESRD. Also renal amyloidosis beyond AL, platinum nephrotoxicity, and non-dilated obstructive uropathy.
The published statistics had drifted badly — the Clinical Mastery total appeared three separate times on the homepage as 124, 79, and 46. Every count on this page and the homepage has been recomputed from the actual files. The site now holds 481 pages: 121 Clinical Mastery reviews across 21 modules, 118 student reference documents with 107 downloadable PDFs across 21 topics, 30 interactive cases, 17 patient handouts, a 28-chapter Primer, and 11 podcasts.
Open Clinical Mastery → · Browse Student Handouts → · Open the Case Report Library →
The Dialysis Advanced Module now includes two home-therapy resources: Home Hemodialysis with NxStage, a 53-reference clinical white paper covering prescription design, flow fraction, dialysate selection, monitoring, vascular access, and evidence-based assessment; and Home Dialysis Tools and Resources, a curated guide to public HHD and PD tools. Facility standing orders, internal FMC algorithms, and individual staff contact information remain private and were not published.
Open the Dialysis Advanced Module →
Two new physician-level reviews joined the Clinical Mastery Series: Hypertensive Nephropathy (in Hypertension Advanced, cross-listed under CKD Advanced — the topic spans both) and a new Stone Disease topic launching with The Metabolic Stone Workup & the Evidence Behind Stone Prevention — 24-hour urine interpretation, risk-factor–directed therapy, and a critical appraisal of the prevention evidence.
Open the Clinical Mastery Series →
The new patient-facing section of plain-language kidney-health guides grew from 1 to 17 handouts, adapted from Dr. Bland’s own teaching materials into everyday language for patients and families. They are grouped into six areas: understanding kidney disease, medications, food and lifestyle, tests, dialysis, and stones/infections.
| Group | Handouts |
|---|---|
| Understanding Kidney Disease | What Is CKD? · Diabetes and Your Kidneys · CKD Complications · IgA Nephropathy |
| Medications and Your Kidneys | GLP-1 Medicines · SGLT2 Inhibitors · ACE Inhibitors & ARBs · Water Pills (Diuretics) · NSAIDs and Your Kidneys |
| Food, Diet & Lifestyle | Eating Well with Kidney Disease · Potassium · Phosphorus · Home Blood Pressure |
| Tests, Dialysis, Stones | Kidney Biopsy · Understanding Dialysis · Kidney Stones · Preventing UTIs |
A new audience-scoped track for Clarke University Doctor of Physical Therapy students. The DPT curriculum is a bolt-on to the main PA/rotator curriculum — focused on the cardiorenal and nephrology knowledge that PTs need at the bedside and in cardiac rehab, without medication decisions that stay with the prescribing team.
| Component | What's there |
|---|---|
| DPT Landing | curriculum-udpt-pt.html — audience-scoped entry point with cross-links to lectures, handouts, cases. |
| Full PT Lectures (5) | Hydration · High-Salt Foods · Protein for the CKD Patient · Creatine & Kidney Function · NSAIDs & Pain Management. Each with learning objectives, case vignettes, MCQs, and PubMed-cited references. |
| PT Student Handouts (6) | Hydration · High-Salt Foods · Protein · Creatine · NSAIDs/Pain · GLP-1 Receptor Agonists (sarcopenia, peri-op holds, exercise Rx). |
| PT Interactive Cases (5) | Beta-blockers in HFrEF cardiac rehab · SGLT2i + peri-op DKA · Diuretics & triple-whammy AKI · ACEi/ARB/ARNI transitions & angioedema · RAAS + diuretics + heat/orthostasis. All with MCQ + click-for-explanation. |
Five new PT-focused cardiorenal cases added to the interactive case library, all following the enhanced MCQ + click-for-answer pattern with integrated learning points and module cross-links.
Three new curriculum entry points replace the single all-in-one curriculum page for the three main audiences:
Pagefind-powered full-site search is now on every landing page — indexed at deploy time, theme-aware (light/dark), with blue underlined result links. Type any term in the search box at the top of any curriculum page.
76 comprehensive reference handouts across 18 nephrology topics, designed for PA students, medical students, and residents. Each handout features a polished article layout with sidebar table of contents, dark/light mode, and downloadable PDF.
The AKI module grew from 3 pages to 14 deep-dive reviews, now organized into four thematic sections incorporating the KDIGO 2026 AKI/AKD Guidelines.
| Section | New Content |
|---|---|
| Evaluation | AIN & GN Diagnostic Methodologies |
| Etiology | Pre-renal AKI (Cardiorenal/Hepatorenal Syndromes) |
| Etiology | Acute Tubular Necrosis: Intrinsic & Extrinsic |
| Etiology | Obstructive Nephropathy & Imaging |
| Etiology | Retroperitoneal Fibrosis & IgG4-Related Disease |
| Drug-Induced | Drug-Induced AKI Overview & Framework |
| Drug-Induced | Antibiotic-Associated Kidney Injury (12,600 words) |
| Drug-Induced | PPI Nephrotoxicity & AIN |
| Management | KRT Timing & Modality (STARRT-AKI, ELAIN, AKIKI) |
| Management | Loop Diuretics & Furosemide Stress Test |
43 new deep-dive clinical reviews added across 7 mastery sections, drawn from the clinical vault and curated for educational quality (3,000+ word threshold).
| Section | New Pages | Highlights |
|---|---|---|
| Onconephrology | +7 | ICI treatment (MD Anderson), CAR-T kidney, TLS, VEGF/TKI toxicity |
| Electrolytes | +9 | RTA comprehensive (9.3K), metabolic alkalosis (7.9K), ICH hyponatremia |
| Cardiorenal | +6 | Comprehensive report (10.9K), HFpEF roundtable, SGLT2i in T1DM |
| Glomerular | +5 | Lupus nephritis treatment (12.3K), MGUS vs MM scoring (12K) |
| Edema | +3 | Sequential nephron blockade (13.5K), medications causing edema |
| Dialysis | +3 | Enterococcal endocarditis on HD, CCHT exam module |
| CKD | +1 | CKD-MBD comprehensive review |