Volume 12 Issue 1, January 2016

Treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) can be challenging. Now, data from the phase III C-SURFER study show that grazoprevir and elbasvir — a new all-oral combination therapy for HCV — is safe and effective in patients with stage 4–5 CKD.

Fluid therapy with saline is considered by some to confer a notable risk of acute kidney injury and mortality. However, data from the SPLIT trial — the first large, randomized controlled trial to compare saline to a 'balanced' solution — do not indicate any marked signal of harm in critically ill patients.

Over the past decade remote ischaemic preconditioning (RIPC) has evolved as a promising strategy to reduce ischaemia in remote organs. Although previous studies using surrogate outcomes have encouraged further investigation, two recent randomized controlled trials — the ERICCA trial and the RIPHeart Study — were unable to detect a protective effect of RIPC.

A recent subanalysis of data from the PEGASUS-TIMI 54 trial indicates a favourable balance between the efficacy and safety of ticagrelor in patients with prior myocardial infarction (MI), irrespective of their renal function. These results support the long-term use of ticagrelor in patients with chronic kidney disease and prior MI.

Pattern recognition receptors and danger-associated molecular patterns of the innate immune system contribute to the initiation of an inflammatory response in diabetes mellitus and diabetic nephropathy. In this Review, Jun Wada and Hirofumi Makino discuss how these components of the innate immune system can lead to insulin resistance, diabetes mellitus, and renal failure and describe signalling mediators and pathways that could be targeted for treatment.

The term 'hypertensive nephrosclerosis' is often used to define chronic kidney disease in non-diabetic patients with mild-to-moderate hypertension and low level or absent proteinuria; however, this terminology implies that the hypertension is causative of the kidney disease. Here, Barry Freedman and Arthur Cohen describe the differences between genetically mediated forms of glomerulosclerosis and arteriolar nephrosclerosis that is potentially related to hypertension and other vascular disease risk factors. They argue that the term 'hypertensive nephrosclerosis' should be replaced with terminology that better reflects the underlying disease aetiology, to improve diagnostic accuracy in this field.

HDL exerts anti-inflammatory, antioxidative, and antithrombotic effects in healthy individuals. In this Review, Nosratola Vaziri outlines how HDL structure and function and reverse cholesterol transport is perturbed in patients with nephrotic syndrome, chronic kidney disease, and end-stage renal disease. The underlying mechanisms that contribute to HDL abnormalities and the consequences of these abnormalities, such as progression of cardiovascular complications, are discussed, as well as current treatment options.

Acute kidney injury (AKI) is highly prevalent in patients admitted to the intensive care unit, and many of these patients also develop concomitant respiratory complications. In this Review, Faubel and Edelstein discuss the traditional and non-traditional complications of AKI, focusing in particular on the pathologic mechanisms that underlie respiratory complications and the mediators of AKI-induced pulmonary inflammation.