Volume 11 Issue 2, February 2015

Knowledge of the pathogenesis of glomerular disease and approaches to therapy continued to advance in 2014. Key studies identified thrombospondin type-1 domain-containing protein 7A as an antigenic target in primary membranous nephropathy, and demonstrated efficacy of rituximab as maintenance therapy in relapsing or steroid-dependent nephrotic syndrome and antineutrophil cytoplasmic antibody-associated vasculitis.

In 2014, key studies in the field of diabetic nephropathy highlighted the importance of albuminuria as a predictor of cardiovascular risk and showed that the incidence of renal and cardiovascular complications is decreasing. Promising efficacy data were obtained with atrasentan, whereas a trial of bardoxolone methyl led to safety concerns.

Chronic kidney disease (CKD) is an established independent risk factor for increased cardiovascular events and cardiovascular mortality. During 2014, several research efforts focused on clarifying the complex pathophysiology, assessing the prognostic associations and improving the treatment of cardiovascular disease in patients with CKD.

Several studies published in 2014 might facilitate improvements in the treatment and long-term care of renal transplant recipients. The potential risks of living kidney donation, the efficacy and safety of alemtuzumab-based induction therapy, and the treatment of chronic hepatitis E virus infection have been addressed.

In 2014, key articles in the field of acute kidney injury highlighted the importance of tubular homeostasis in renal regeneration. Cell cycle regulators, inflammatory signals and progenitors were identified as important factors that mediate the balance between inflammation and tubular regeneration necessary for renal repair.

Focal segmental glomerulosclerosis is a heterogeneous disease characterized by primary podocyte injury or a lesion that occurs secondarily in any form of chronic kidney disease. In this Review, Agnes Fogo reviews the causes and pathogenesis of primary and non-immunologic adaptive secondary types of FSGS.

The immune system has a vital role in the renal response to acute kidney injury (AKI). In this Review, Hye Ryoun Jang and Hamid Rabb describe current understanding of the function of the innate and adaptive immune systems in the early and late injury phases of ischaemic and nephrotoxic AKI, and describe the influence of immune cells on recovery and long-term outcome following AKI.

Mutations in hepatocyte nuclear factor 1β (HNF1B) are the most common monogenic cause of developmental kidney disease. Affected patients commonly present with renal cysts; however, this condition is characterized by its diversity of renal and extra-renal phenotypes. Here, the authors analyse the clinical phenotypes, the spectrum of causative heterozygous HNF1B mutations, discuss the molecular pathways by which HNF1B might contribute to renal pathologies, and identify areas for future molecular, genetic and clinical research in HNF1B-associated disease.

Conventional diuretics target salt transporters in kidney tubules, but urea transporters have emerged as alternative targets for small-molecule salt-sparing diuretics. This Review summarizes the structure, expression and function of urea transporters and describes the evidence supporting the validity of using small-molecule inhibitors of urea transporters as salt-sparing diuretics.