Volume 10 Issue 11, November 2014

Podocyturia in patients with pre-eclampsia has been widely documented, but the underlying pathology is unknown. A new study highlights the glomerular histological alterations in a unique Dutch cohort of deceased patients with pre-eclampsia. The results suggest an important, albeit controversial, role of parietal epithelial cells in this context.

Two recent population-based studies reported higher death rates in patients given metoprolol tartrate than in those given atenolol. These observations contrast with those of a US study in which patients with known cardiovascular disease were excluded, suggesting that indication bias or residual confounding might account for the difference in findings.

A new study suggests that peritoneal dialysis achieves a favourable mortality outcome compared with haemodialysis for the first 2 years of treatment. However, registry-based comparisons of mortality outcomes in patients with end-stage renal disease on either renal replacement modality are often fraught with complications.

The KDIGO recommendation for blood pressure management in patients with chronic kidney disease and proteinuria is based partly on underpowered subgroup and post hoc analyses. New observational data, however, demonstrate that lower blood pressure goals may be harmful in this group of patients.

In the general population, risk of cardiovascular disease is inversely associated with HDL-cholesterol levels. However, a new post hoc analysis of data from the German Diabetes Dialysis study reports no correlation between HDL cholesterol and mortality among patients on dialysis—a phenomenon that the authors attribute to HDL dysfunction.

Although intradialytic hypertension is associated with all-cause mortality, the mechanisms that underlie this phenomenon are not well understood. Now, Nongnuch et al. report that post-dialysis hypertension is associated with extracellular fluid overload, and suggest that patients with this condition might benefit from increased dialysis session length or frequency.

Renal dendritic cells and macrophages are key factors in the initiation and propagation of renal disease and tissue regeneration. In this Review, the authors discuss the common and distinct characteristics of dendritic cells and macrophages as well as current understanding of the renal-specific functions of these important phagocytic, antigen-presenting cell types in potentiating or mitigating intrinsic kidney disease.

The cost and cost-effectiveness of dialysis therapy for patients with end-stage renal disease is a key consideration for health-care providers, particularly given the increasing prevalence of chronic kidney disease worldwide. Here, Klarenbach and colleagues discuss available data comparing the relative cost and cost-effectiveness of various dialysis modalities, including variations in the intrinsic costs of the different modalities and other factors, such as economic differences between high-income and low–middle-income nations.

Hyperkalaemia is common in patients with chronic kidney disease and is associated with adverse outcomes. Here, Csaba Kovesdy gives an overview of the mechanisms underlying hyperkalaemia and its clinical consequences in this patient population, and discusses current treatment regimens, as well as emerging therapies that might enable the more-liberal use of beneficial therapeutics in specific populations of patients at risk of hyperkalaemia.

Each year, over 70,000 organs are transplanted worldwide. The degree of risk of transmission of infection from transplanted organs to the recipient is largely unknown and is difficult to assess for specific organs. Here, Jay A. Fishman and Paolo A. Grossi describe the major risk factors for organ donor-derived transmission of infection and discuss opportunities to reduce the incidence of such events.