Volume 10 Issue 2, February 2014

2013 saw the publication of numerous studies that identified resident renal stem or progenitor cells, induced pluripotent stem cells and strategies based on stem cell paracrine action, which all might be suitable for kidney regeneration after injury.

In 2013, substantial progress was made in uncovering the genetic basis of a variety of kidney and urological disorders, including congenital and developmental diseases. The new findings will lead to an increased understanding of the pathophysiology of these diseases, improved risk prediction and the development of novel therapies.

During 2013, a meta-analysis provided evidence that cystatin C improves estimated glomerular filtration rate in cardiovascular risk categorization in chronic kidney disease (CKD). Another study showed that low diastolic blood pressure (DBP) is harmful in patients with CKD, challenging the paradigm of treating elevated systolic blood pressure regardless of DBP. Overall, mortality rates in CKD have decreased but further improvement is required.

In 2013, a key theme of research in renal transplantation was the diagnosis of rejection. Data from key studies published in the past year highlight aspects of rejection that warrant further investigation and should prompt the consideration of adjunctive tests to complement traditional histological assessment of allograft biopsy samples.

In 2013, four important papers were published that provide new insights on biomarkers in acute kidney injury (AKI). These studies demonstrate the potential for biomarkers to aid clinicians in improving the therapeutic management of patients with AKI and potentially improve patient outcomes.

In diabetic nephropathy, excessive activation of the renin–angiotensin–aldosterone system (RAAS) results in progressive renal damage. Here, the authors discuss the efficacy of RAAS blockade for the prevention of disease progression and the mechanisms of renal protection. They also highlight new strategies aimed at optimizing RAAS blockade and improving outcomes in patients with diabetic nephropathy.

As current treatment strategies for diabetic nephropathy, namely intensive control of glucose levels and blood pressure, cannot fully prevent the development and progression of the disease, new therapeutic approaches are urgently needed. Here, Muskiet and colleagues discuss the status of currently available incretin-based agents—agonists of glucagon-like peptide 1 and inhibitors of dipeptidyl peptidase 4—and their potential renoprotective effects in patients with type 2 diabetes mellitus.

In the past two decades, podocyte signalling pathways and networks of extreme complexity, with multiple interconnections and feedback loops, have been discovered. In this Review, the authors summarize the basic principles of signal transduction and discuss the physiological and pathological roles of receptor tyrosine kinase signalling in podocytes.

Management of chronic kidney disease in elderly patients is challenging and complex. In this Review, the authors discuss the dilemmas that are associated with the planning and maintenance of a preferred vascular access for haemodialysis in elderly patients, including the ethical issues that might influence therapeutic decision making.