Volume 11 Issue 1, January 2015

A 6-year follow-up study of the ADVANCE trial participants reports that intensive glycaemic control is renoprotective—but does not reduce mortality—in patients with type 2 diabetes mellitus. By contrast, a post hoc analysis of the ACCORD trial suggests that intensive glycaemic control might increase mortality in patients with diabetic nephropathy.

A new study demonstrates that knockdown of miR-193a in human parietal epithelial cells induces their differentiation into podocytes. Inhibition of miR-193a in a model of nephrotoxic nephritis resulted in reduced proteinuria and crescent formation. These data suggest that promoting differentiation of parietal progenitors into podocytes has potential therapeutic relevance.

It is now accepted that climate change is occurring as a result of human activity and that it will have potentially devastating effects on health. Nephrologists are likely to see a changing spectrum of disease as a consequence of climate change and are ideally placed to lead mitigating strategies in health-care provision.

Findings from the ARISE and TRISS trials indicate that protocolized therapy might be no better than contemporary management for patients in intensive care, and that in the absence of coronary disease a haemoglobin level of 70 g/l should be the new trigger for transfusion in patients with sepsis.

New data suggest that aortic stiffness results in the transmission of excessive flow pulsatility to the renal microcirculation. Further understanding of the mechanisms that regulate the relationship between large arteries and the renal microcirculation could lead to new strategies to protect the kidneys from increased blood pressure load owing to systemic hypertension.

Insights into the pathogenesis of membranoproliferative glomerulonephritis (MPGN) have transformed our understanding of the processes that can lead to the morphological appearance of this pattern of injury. It is now recognized that many cases of MPGN are characterized by the deposition of the complement component C3 in glomeruli without immunoglobulin deposition; this group of diseases is now referred to as C3 glomerulopathies. In this Review, Cook and Pickering discuss the morphological features of MPGN and their different associated pathological processes, in addition to the histological features of C3 glomerulopathies.

The important roles of microRNAs (miRNAs) in kidney development, homeostasis and disease are becoming increasingly recognized. These small, non-coding RNA molecules are now understood to participate in the onset and progression of pathways involved in development of end-stage renal disease; they therefore represent potential new therapeutic targets for halting progression of chronic kidney diseases. This Review describes current research investigating the roles of miRNAs in normal kidney physiology and diseases with particular attention given to the TGF-β1 pathway and its regulation by miRNAs.

Increasing evidence suggests that autophagy can modulate tissue responses during acute kidney injury, regulate podocyte homeostasis and protect against age-related renal disease. In this Review the authors describe the process of macroautophagy and its role in kidney health, ageing and disease. They also highlight the potential of autophagy as a target for renoprotective therapies.

Lupus nephritis is a severe manifestation of systemic lupus erythematosus and a major cause of both acute kidney injury and end-stage renal disease. Preventing, or delaying progression of lupus nephritis is the primary objective of treatment. New treatments, or treatment regimens have substantially improved the overall prognosis of patients with lupus nephritis over the past 30 years. Here, Tak Mao Chan provides a detailed summary of the clinical efficacy of current treatment approaches, and the potential roles of emerging treatments for lupus nephritis.