Volume 11 Issue 10, October 2015

Maintaining steroid-free remission in children with idiopathic nephrotic syndrome is an important goal of therapy. A new trial provides evidence that mycophenolate mofetil can be added to the list of effective steroid-sparing agents. The majority of participants relapsed, however, highlighting an unmet need for more effective treatment modalities.

A new study reports that state-level policies have had little effect on rates of organ donation in the USA, highlighting the limited ability of scattered initiatives to have a national effect. Regardless of their impact on donation rate, a need exists for policies that make donation financially neutral for donors.

Elevated levels of fibrobast growth factor 23 (FGF-23) are associated with cardiovascular and all-cause mortality in patients with kidney disease. A secondary analysis of the EVOLVE trial reports that cinacalcet-induced reductions in FGF-23 were associated with a reduced risk of cardiovascular events in patients with secondary hyperparathyroidism on dialysis.

The constitutive uptake and degradation of filtered albumin by the proximal tubule has resulted in this process being relegated a passive player in albuminuria. Real-time intravital imaging of the rat kidney now describes a new paradigm in which the proximal tubule dynamically increases or decreases albumin uptake following changes in plasma albumin levels.

Nephrogenic diabetes insipidus (NDI) is caused by inability of the kidneys to respond to arginine vasopressin and concentrate urine by reabsorption of water in the collecting duct. The disease can be congenital or acquired and has a substantial detrimental effect on the quality of life of affected patients. In this article, Bockenhauer and Bichet review the pathophysiology, diagnosis and current clinical management of NDI as well as potential future treatment strategies.

Vascular abnormalities, particularly those associated with rupture of intracranial aneurysms (IAs) or arterial dissections are among the most serious complications of autosomal dominant polycystic kidney disease (ADPKD). In this article, the authors discuss the pathophysiological mechanisms that might be involved in the development of vascular complications in patients with ADPKD and review strategies for screening, diagnosis and treatment of IAs in this population.

IgG4-related disease can affect any organ system, including the kidney. Renal involvement is an indication for prompt treatment, owing to an increased risk of chronic kidney disease. In this Review, Frank Cortazar and John Stone provide an overview of systemic IgG4-related disease before describing in detail the renal manifestations of IgG4-related tubulointerstitial nephritis and membranous glomerulonephropathy secondary to IgG4-related disease. They consider the pathophysiology, as well as current and future treatment options.

The identification of modifiable risk factors that are associated with declining renal function is required to stem the increasing incidence of chronic kidney disease worldwide. In this Review, Howard Trachtman and colleagues discuss the impact of environmental chemicals on cardiorenal function. They highlight the ubiquity of exposure to environmental chemicals in the general public, the main sources of contamination, and the predominant adverse effects that might affect renal function.