Volume 11 Issue 3, March 2015

'Chronic kidney disease (CKD) in disadvantaged populations' is the focus of World Kidney Day 2015. In this article, we discuss the disproportionate burden of CKD in disadvantaged communities as well as approaches to ensure the provision of appropriate renal care across socioeconomic and ethnic groups.

New research suggests that rigorous blood pressure control is beneficial in early autosomal dominant polycystic kidney disease (ADPKD). Although a positive effect on the rate of decline of estimated glomerular filtration rate remains to be demonstrated, this study is likely to change current treatment strategies for young patients with ADPKD.

Maintenance therapy for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) should reduce rates of relapse with minimal toxicity. The MAINRITSAN trial—the first randomized controlled trial to compare the efficacies of rituximab and azathioprine in AAV remission maintenance—has demonstrated a superior outcome using rituximab. These data have important implications for the management of AAV.

The authors of a new study report that independent of renal disease, any level of glycaemia is associated with increased mortality risk in patients with type 1 diabetes mellitus. However, this view may be overly simplistic—a multifactorial approach is required to reduce excess mortality in this population.

Fetal exposure to an adverse intrauterine environment is associated with an increased risk of numerous chronic diseases in later life. Here, Luyckx and Brenner highlight the emerging developmental risk factors for chronic kidney disease and hypertension, including high birth weight, maternal diabetes mellitus and rapid growth during childhood. The authors discuss the burden imposed on resource-poor countries by suboptimal nutritional intake, and address the benefits of nutritional interventions in reducing the global epidemic of these chronic diseases.

HIV infection is associated with renal diseases including HIV-associated nephropathy, HIV-immune-complex kidney disease, thrombotic microangiopathy and disorders associated with nephrotoxic HIV therapies. Here, the authors review the epidemiology, histopathology, mechanisms, genetic susceptibility, diagnosis and treatment of HIV-associated nephropathies and highlight remaining questions for future research.

The complex vascular pathobiology of sickle cell disease leads to renal manifestations that affect almost all physiological process in the kidney. Renal complications are diverse, ranging from altered haemodynamics and impaired urinary concentrating ability to glomerulopathies, chronic kidney disease, acute kidney injury and renal medullary carcinoma. In this Review, Karl A. Nath and Robert P. Hebbel provide an overview of sickle cell disease and consider the underlying pathogenetic mechanisms of the renal manifestations.

Hepatitis C virus (HCV) infection imposes a substantial economic, clinical, and societal burden worldwide. In this Review, Morales and Fabrizi compare the treatment options that are available to patients with HCV infection, before and after renal transplantation. The development of novel therapeutic strategies and the clinical complications associated with HCV infection are discussed. The authors conclude with an assessment of the safe use of organs donated from individuals with active HCV infection.

Implementation of programmes for dialysis, transplantation and renal-disease screening in developing countries is a complex and challenging task. Here, the authors provide the perspective of their efforts to implement renal care in Haiti. They focus on the importance of collaboration, education and partnership building, rather than on technological issues.

In many low-to-middle income countries (LMICs) access to essential medications is limited and the number of clinical trials conducted is small because of regulatory issues and a lack of infrastructure. In this article,Nature Reviews Nephrologyasks three experts their opinions on how to improve drug access and increase the numbers of clinical trials conducted in LMICs.

The medical challenges faced by low-to-middle income countries (LMICs) are myriad, and are compounded by a lack of resources for treatment. Given that nephrology can be an 'expensive' specialty, requiring specialized equipment for dialysis and transplantation, patients with kidney diseases in LMICs are particularly vulnerable. Additionally, different regions have different prevailing diseases—such as HIV infection, sickle cell disease and HCV infection—that manifest in the kidney in unique ways, require expert care and are challenging in under-resourced settings. In all LMICs, issues of nutrition and birth weight abound, which have been shown to affect nephron number at birth and, consequently, lifelong renal function. This special issue of Nature Reviews Nephrology has been commissioned to shed light on a range of issues facing the renal health of the developing world, from infectious agents that manifest in the kidneys to setting up treatment facilities in challenging circumstances.