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Cover image supplied by Miriam Boersema, University of Groningen, University Medical Center Groningen, Netherlands. Immunofluorescent image of the extracellular matrix in a glomerulus from an allografted rat kidney. The double staining shows the spatial relationship between collagen I and collagen IV. Original lens magnification 40x.
A new study has addressed a key question in autosomal dominant polycystic kidney disease (ADPKD): can we predict renal outcome at an early disease stage? Indeed, this information is useful for any patient with ADPKD. Moreover, while targeted therapies continue to emerge, optimal selection of patients for clinical trials remains a challenge.
A new study suggests that use of unadjusted dosages of β-lactam antibiotics could reduce the risk of inadequate serum concentrations during continuous renal replacement therapy. However, risk of overdose compounds the problem. Therapeutic drug monitoring, pharmacokinetic modelling and dose simulation might provide opportunities to improve dose precision and patient outcomes.
A new study has advanced our understanding of iron management in chronic kidney disease (CKD) by comparing oral iron to high-dose and low-dose intravenous ferric carboxymaltose (FCM) in patients with predialysis CKD. Intravenous FCM treatment to achieve a higher serum ferritin target improved patient haemoglobin levels and reduced initiation of other anaemia treatments.
Despite an explosion in understanding of the disease process, the rates of patients with autosomal dominant polycystic kidney disease starting renal replacement therapy show no signs of slowing. Indeed, rates among people aged ≥70 years have increased, reflecting a greater propensity to offer renal replacement therapy to this age group.
Renal fibrosis is caused by renal inflammation, although the underlying mechanisms are unclear. Here, the authors discuss the function of tubular epithelial cells and specific leukocytes—including macrophages, CD4+T cells and mast cells—in the progression from inflammation to fibrosis, as well as the prevention of fibrosis.
Muscle atrophy frequently complicates the course of chronic kidney disease (CKD) and is associated with excess morbidity and mortality. In this Review, the authors describe how CKD stimulates catabolic pathways that interfere with cellular protein metabolism and discuss how knowledge of these pathways might enable the development of therapies to block muscle wasting in catabolic conditions.
Further understanding of the molecular mechanisms underlying the pathogenesis of diabetic nephropathy is necessary for the improved management of the disease. In this Review, the authors discuss the emerging evidence that suggests a key role for epigenetic mechanisms and noncoding RNAs in the pathogenesis of diabetic nephropathy and metabolic memory—the phenomenon of prolonged benefits of good blood glucose control.
Current management of pre-eclampsia consists of controlling maternal hypertension, preventing seizures and delivering the fetus at term. To aid clinical management, efforts are underway to identify biomarkers that can predict pre-eclampsia as early as the first trimester. In this second part of their Review on pre-eclampsia, Chaiworapongsa and colleagues describe these efforts, as well as the current management strategies for these patients.