Volume 11 Issue 6, June 2015

Corticosteroids are frequently used to treat patients with IgA nephropathy (IgAN) despite a paucity of data to support their use in individuals with substantially reduced renal function. A retrospective study provides evidence that these agents may slow the rate of decline in renal function in high-risk patients with IgAN.

Strategies for the management of hypertension in patients with type 2 diabetes mellitus are controversial. New data from a landmark meta-analysis support the use of antihypertensive therapy in these patients but the impact of blood pressure-lowering on albuminuria and progression of chronic kidney disease remains unclear.

Automated, real-time alert systems have the potential to improve recognition and management of acute kidney injury (AKI). A recent patient-level, randomized controlled trial, however, demonstrated no effect of such a system on AKI progression, receipt of dialysis or death. These findings inform the future implementation and testing of AKI alerts.

Although consensus guidelines promote the use of arteriovenous fistulas for vascular access, the vast majority of US patients initiate haemodialysis using a central venous catheter. Malas et al. evaluate the impact of the type of incident vascular access on patient survival after initiation of haemodialysis.

Variation exists in the number and utility of diagnostic tests performed at nephrology referral. Recent data suggest that a large battery of diagnostic tests might be unnecessary and costly for the majority of patients. A risk-based approach to triage could instead help inform which patients will benefit from intensive testing.

The traditional definition of sepsis requires the presence of at least two systemic inflammatory response syndrome (SIRS) criteria in addition to a suspected or proven infection. A recent large retrospective study, however, suggests that the requirement for two SIRS criteria excludes one in eight patients with severe sepsis.

Systemic lupus erythematosus (SLE) is a complex, autoimmune disorder that can have debilitating effects on various organs, including the kidneys. Here, Mohan and Putterman discuss the genetic candidates associated with SLE and lupus nephritis, and highlight possible molecular mechanisms that might contribute to disease pathology. Given the highly variable clinical presentation of SLE, the authors propose that greater understanding of the molecular basis of SLE and lupus nephritis is required to facilitate the generation of specific tailored therapies in the future.

Resident microorganisms in the human body vastly outnumber host cells and have an important role in human physiology. In this Review, Bromberg and colleagues discuss the basic principles that guide analyses of the microbiota, including the challenges of measuring and quantifying microbiota. They also discuss the influence of the microbiota on the immune system and the implications of these effects on organ failure and transplantation.

The development of novel targeted anticancer agents has led to improved outcomes for many patients with various malignancies, but use of these agents may be associated with an increased risk of adverse events, including renal toxicity. Here, Camillo Porta and colleagues discuss current understanding of the renal toxic effects of targeted anticancer agents and the potential use of these agents in patients with renal disease.

Renal transplantation is the optimal form of renal replacement therapy for children with end-stage renal disease; however, disease recurrence can lead to graft loss, morbidity and death. In this Review, Justine Bacchetta and Pierre Cochat provide an update on the epidemiology, pathophysiology, effects and management of disease recurrence after paediatric renal transplantation. They also describe pretransplantation and post-transplantation risk-reduction strategies that aim to minimize the possibility of disease recurrence, and thus improve both graft and patient outcomes.