Volume 10 Issue 1, January 2014

Parietal epithelial cells (PECs) are increasingly recognized as key players in the pathogenesis of proliferative glomerular diseases. A new study by Rizzo and colleagues contributes to this emerging concept and identifies potential novel signalling pathways that might mediate the activation of PECs. However, the functional role of PECs remains controversial.

The ACP has published 'weak' guidelines for screening patients for kidney disease based on limited or no data, which could harm patients with undiagnosed or progressive kidney disease. As kidney experts weren't involved in the development of these guidelines, what should all health professionals know about screening for kidney disease?

Two recent studies suggest that periprocedural statin administration can prevent contrast-induced acute kidney injury in cardiac patients undergoing percutaneous coronary intervention and in renal patients undergoing angiography, with or without intervention. These studies support the routine administration of potent statins before contrast media infusion in these vulnerable patients.

American and European vascular access guidelines advise intensive surveillance of haemodialysis arteriovenous fistulas (AVFs) with pre-emptive access intervention based on deterioration in access flow. The combination of physical examination, venous pressure and access flow might provide a better indicator of need for intervention and reduce the risk of AVF thrombosis and access loss.

Protein–energy wasting occurs frequently during maintenance dialysis. Known aetiologies include a loss of nutrients during the haemodialysis procedure and anorexia. Providing energy and protein during dialysis improves metabolism; however, the benefits of long-term support are debated. Weiner and colleagues report convincing data with an intradialytic oral nutritional intervention using protein supplements.

A new study presents compelling evidence of an association between moderate to severe psoriasis and chronic kidney disease (CKD). This association seems to be independent of traditional CKD risk factors and indicates that monitoring of kidney function in patients with psoriasis is warranted.

Co-inhibitory and co-stimulatory signals that are expressed upon T-cell-activation influence both autoreactive and alloreactive T-cell responses. Here, the authors describe the functional importance of T-cell co-stimulatory molecules in transplantation, tolerance and autoimmunity, and how therapeutic blockade of these pathways might be harnessed to manipulate the immune response to prevent or attenuate pathological immune responses.

Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides are characterized by inflammation of blood vessels, which can lead to severe organ and tissue damage. Previously considered life-threatening, they are now treated using remission induction and maintenance therapies. This article outlines the current treatment regimens, reviews clinical trial data, and discusses new developments in the treatment of ANCA-associated vasculitides.

Fluid therapy is essential to maintain renal oxygen delivery and glomerular filtration in patients who are at risk of acute kidney injury (AKI). However, patients with AKI are also at risk of fluid overload. This Review discusses the optimal fluid management strategy for patients with AKI, and the need to balance adequate shock resuscitation with the harmful effects of fluid overload.

Cardiorenal syndrome comprises a heterogeneous group of acute and chronic conditions, which affect patients with combined cardiac and renal dysfunction. Although cardiorenal syndrome is widely recognized, research in this field is hampered by the lack of a universally accepted definition and limited understanding of the hierarchy of factors involved in pathogenesis of the disease. Here, the authors discuss the current understanding of cardiorenal syndrome and suggest a roadmap for future research.

The underlying cause of hypertension is unknown in the vast majority of patients with high blood pressure. This Perspectives article discusses the role of T cells in renal inflammation and how autoimmunity, mediated by heat shock proteins, leads to salt-sensitive hypertension.