News & Views in 2012

Studies of the association between BMI and complications after transplantation have reported variable results. BMI may be a deficient measure of obesity; therefore, a better measure of obesity and improved definition and follow-up of complications related to obesity may strengthen the estimation of post-transplantation risk in obese patients.

The link between chimerism and tolerance is well established. In a rhesus macaque study, Ramakrishnan et al. show that the type of chimerism might have an important effect on tolerance to kidney allografts, pointing to a critical role of donor T-cell production for success. These findings could directly impact clinical efforts to induce tolerance to allografts.

A study by Bojan et al. of neonates and infants who received peritoneal dialysis for the treatment of acute kidney injury following cardiac surgery revealed that the early initiation of dialysis was associated with a significantly decreased mortality rate compared with delayed dialysis.

A survey of seven countries has found a striking difference in dialysis reimbursement policies, even when data were adjusted for gross domestic product per capita. Although increased reimbursement is perceived to be a valuable incentive for certain treatments, this perception is not supported by current data and alternative strategies to promote home-based dialysis should be pursued.

In a new study, Schwartz and colleagues have investigated the best way to estimate glomerular filtration rate (GFR) in children. Having already improved GFR estimation with the use of creatinine-based equations, the investigators now propose a more precise method for cystatin C measurement. The precision of a GFR equation will strongly depend on the analytical precision of the biological variables included.

The American College of Rheumatology recently published guidelines for the screening, treatment, and management of lupus nephritis. How will or should these guidelines impact our current daily practice?

Several immunosuppressive treatments have demonstrated their efficacy in idiopathic membranous nephropathy, but spontaneous remission does develop in more than 30% of patients. The availability of a validated biomarker that is easy to measure and able to accurately predict long-term outcomes would be very helpful for tailoring treatment of the disease to the individual.

Dialysis, particularly haemodialysis, is associated with an increased risk of cardiovascular disease. A new study confirms that hypokalaemia confers an excess cardiovascular risk and contributes disproportionately to the high risk of death in patients on peritoneal dialysis, which may partially account for the fact that observed cardiac risk is similar for patients on peritoneal dialysis and haemodialysis.

In a new study, Porcheray et al. provide evidence that a single antibody generated by alloimmunization can recognize multiple antigens in a paradigm-changing fashion. Although these results require confirmation, the presence of polyreactive antibody may offer an explanation as to why some patients with a single sensitizing event develop a wide breadth of panel-reactive antibody.

The use of statins as a line of primary prevention in individuals at low risk of cardiovascular events is an area of debate. The most recent meta-analysis from the Cholesterol Treatment Trialists' (CTT) Collaboration suggests that present guidelines for prescribing statin therapy may need to be reconsidered.

Previous studies have indicated that ablation of renal sympathetic nerves reduces blood pressure in patients with resistant hypertension and preserved renal function. Hering et al. have now investigated the efficacy and safety of this procedure in patients with moderate to severe chronic kidney disease.

A defect in urine-concentrating ability is discernable in patients with autosomal dominant polycystic kidney disease (ADPKD) before any decline in glomerular filtration rate, and is associated with elevated concentrations of vasopressin and copeptin. This defect is 'urea-selective' and accordingly, the urine-to-plasma ratio of urea concentration could be a clinically relevant early marker of renal dysfunction in patients with ADPKD.

Although children with Wilms tumor now have excellent survival rates, some develop end-stage renal disease (ESRD) owing to immediate nephrectomy or later loss of renal function. According to current recommendations, renal transplantation should be delayed for 2 years following Wilms tumor treatment in children, but data from the National Wilms Tumor Study now question such a waiting period.

Cardiovascular events in patients with diabetes and no history of cardiovascular disease (CVD) are associated with albuminuria rather than kidney disease stage, according to a recent study. Reducing albuminuria, therefore, seems to benefit patients with diabetes but the underlying question still remains—is albuminuria a marker or mediator of CVD?

A comparison by Selistre et al. of several creatinine-based equations commonly used to estimate glomerular filtration rate (GFR) shows that equations developed in adult populations result in substantial overestimation of GFR in adolescents and young adults. Equations developed in pediatric populations were found to have superior performance, but limitations remain for all estimates.

The RASCAD trial investigated the potential benefit of renal artery revascularization versus medical therapy in patients with renal artery stenosis and coronary artery disease. Surprisingly, renal artery stenting seemed to convey no benefit on left ventricular mass. Has all been said and done about renal artery revascularization?

Can treatment delay end-stage renal disease in children with Alport syndrome? New guidelines have been provided based on our ability to identify individuals at risk of early-onset renal failure and on evidence for blockade of the renin–angiotensin system that has been derived from Alport patient registries, other renal diseases and animal studies.

Increased urinary excretion of albumin and creatinine is associated with renal and cardiovascular events. Should the urinary albumin-to-creatinine ratio be considered a combination of two independent risk markers, or is it simply an easy way to obtain the same prognostic information as from a 24 h urine collection?

An observational study associates azithromycin use with accelerated stool decolonization in patients infected with Shiga toxin-producing Escherichia coli O104:H4. Even if this association is causal, however, the value of late-in-illness treatment is not established and the results provide no support for early-in-illness treatment of Shiga toxin-producing E. coli infections.

Sudden death is very common in patients on dialysis, and identifying factors that may lower the risk of sudden death could improve survival of these patients. A recent international comparison of sudden death rates by Jadoul and colleagues gives us insight into how our clinical practice might affect rates of sudden death in dialysis patients.