Volume 13 Issue 2, February 2017

Studies published in 2016 provide insights that bring us closer to achieving the goal of personalized therapy for primary glomerular diseases. Moreover, promising renal outcome data with new classes of glucose-lowering agents — SGLT2 inhibitors and GLP-1 agonists — offer new hope for patients with diabetic nephropathy.

The genetic background of many kidney diseases is complex and involves multiple genes, genetic variants and molecular pathways. Here, we look at how researchers tackled this challenging topic in 2016, focusing on studies that used ingenious data-integration tactics, which led to new insights into kidney disease aetiology and renal disease progression.

Tyrosine kinase inhibitors that target pro-angiogenic pathways improve progression-free and overall survival in patients with metastatic kidney cancer and were thus tested in the adjuvant setting in studies published this past year. 2016 also saw the emergence of new inhibitors of pro-angiogenic pathways that might represent the next step in kidney cancer therapy.

Approaches to effectively prevent and manage organ dysfunction in critically ill patients remain elusive. Key studies in 2016 highlighted the challenges in finding effective treatments for renal failure in sepsis and assessed the optimal timing of renal replacement therapy initiation in critically ill patients with acute kidney injury.

Kidney transplantation was the focus of numerous publications in 2016. Key studies demonstrated a survival advantage of HLA-incompatible kidney transplantation and suggested that novel approaches such as co-stimulation blockade using belatacept and treatment of antibody-mediated rejection using a C1 esterase inhibitor might prove to be future game changers.

Blood pressure (BP) goals and the management of BP in patients with chronic kidney disease (CKD) remain controversial topics. Key articles in the past year have addressed BP goals in CKD, the use of new agents to slow CKD progression and the effects of visit-to-visit variability in systolic BP on cardiovascular events and renal progression in patients with CKD.

Senescent cells, which accumulate with ageing, are also involved in organ development and disease. Here, the authors examine the beneficial and detrimental effects of chronic and acute senescent cells in kidney formation, repair, disease and ageing and how these can be therapeutically modulated.

In many countries, patient outcomes with peritoneal dialysis are comparable or superior to those with haemodialysis. Here, the authors discuss the changing epidemiology of peritoneal dialysis worldwide, including the remaining country-specific challenges that must be overcome to improve utilization of this cost-effective therapy.

Estimates of the prevalence of chronic kidney disease (CKD) vary widely, both within and between countries. Here, the authors discuss the origins of this variation, particularly issues relating to the use of estimated glomerular filtration rate, and present solutions for tackling the factors responsible.

One of the first manifestations of cystinosis is a renal Fanconi syndrome, characterized by severe dysfunction of proximal tubule cells. This Review describes the pathogenesis of renal Fanconi syndrome in cystinosis, focusing on the importance of cystinosin in the maintenance of cellular homeostasis beyond its function in cystine transport.