Year in Review

The year 2012 brought a continued harvest of new findings of relevance to glomerular biology and disease. Progress in glomerular disease has continued, although our understanding of disease processes continues to extend much further than our ability to intervene effectively.

2012 saw the publication of four important trials investigating the choice of fluid therapy in patients suffering from critical illness or undergoing major surgery. These studies pave the way for more evidence-based administration of fluid in such patients.

During 2012, an observational study confirmed the high risk of cardiovascular disease ascribed to chronic kidney disease (CKD) and again raised the question of whether CKD should be considered a cardiovascular disease risk equivalent. Several other studies evaluated methods to mitigate cardiovascular risk in CKD. The results of these studies have advanced the field but have also raised more questions.

Patients with end-stage renal disease typically receive three 3–4 h haemodialysis sessions per week. Although available data from well-powered randomized trials are limited, studies published in 2012 provided new evidence that haemodialysis regimens with longer treatment times and/or a higher frequency of sessions might reduce the high morbidity and mortality of patients on maintenance dialysis.

2012 saw the classification of the systemic vasculitides revised. Genetic studies showed that granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are different diseases with aberrant immune responses to different autoantigens. B-cell depletion with rituximab also acquired a primary role in the treatment of GPA and MPA, as well as in cryoglobulinaemic vasculitis.

Acute kidney injury (AKI) is a syndrome of decreased renal function that is associated with an increased risk of death. Studies from 2011, particularly in the field of AKI biomarkers, have provided important insights into the diagnosis, prognosis, and treatment of AKI. These advances are now being brought to the bedside to improve diagnosis and treatment of AKI.

The past year was marked by several excellent studies that represent important therapeutic advances in kidney transplantation or that further our understanding of the genetic basis of chronic allograft dysfunction, clinical tolerance and outcomes of kidney transplantation.

More than 1.4 million patients are on renal replacement therapy worldwide. Mortality in patients with end-stage renal disease (ESRD) is as high as that seen in some types of metastatic cancer, and premature cardiovascular disease is the major killer in ESRD. Several publications in 2011 addressed how interventions can modify cardiovascular risk factors and improve outcomes.

Research into genetic susceptibilities for proteinuric glomerular diseases has uncovered key pathogenic contributions from inheritable defects in podocytes. However, much less is known about environmental factors that may initiate or propagate podocyte injury. Seminal reports in 2011 provided new mechanistic insights into how this may occur.

Understanding the complex interactions between the various pathways disrupted in polycystic kidney and liver disease is essential to identify and optimize therapies for these disorders. Studies published in the past year have demonstrated a functional interaction between the main proteins implicated in these diseases and identified novel therapeutic approaches.

In 2011, studies of chronic kidney disease (CKD) were published in abundance. The articles selected here represent the growing appreciation of the importance of CKD as a modifier of outcomes, breakthroughs in understanding the pathobiology and genetics of specific conditions, and clinical trials of treatment strategies that offer hope to patients with CKD.

Many patients with diabetic nephropathy progress to end-stage renal disease. New research in disease detection, diagnosis, and novel treatments will hopefully alleviate the burden of diabetic nephropathy in the future.

Few, if any, doubt that renal transplantation should be the first choice of renal replacement therapy whenever this option is possible. But, at which level of remaining kidney function should patients start on dialysis and which dialysis modality should be used? Several studies published in 2010 addressed these questions and will influence dialysis initiation strategies worldwide for years to come.

Several 2010 trials have provided novel information on how best to manage patients with predialysis chronic kidney disease (CKD). Armed with these new findings, nephrologists can find new means of slowing CKD progression by targeting blood-pressure control, acidosis and serum uric acid levels.

Renal transplantation offers the potential for improved quality and length of life to patients with end-stage renal disease; however, graft rejection and immunosuppression-related toxicities can hamper the effectiveness of this therapy. Seminal publications from 2010 have addressed these obstacles, and provide insight into new and innovative approaches to improve outcomes in renal transplant recipients.

Acute kidney injury (AKI) is a serious complication associated with morbidity and mortality. Studies from 2010 have provided insights into the diagnosis and clinical course of AKI, the ability of novel biomarkers to guide therapy, and the quality of life of survivors of severe AKI. It is hoped that these findings will lead to improvements in the diagnosis and prognosis of affected individuals.

2010 saw the publication of a number of papers that provide new information on the relationship between blood pressure and the kidney. The data reinforce the need for future studies to jointly consider cardiovascular and renal outcomes.