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Renal pathological changes seen in individuals with the zoonotic disease leptospirosis include interstitial nephritis and tubular necrosis. With a particular emphasis on the role of hemodynamics, this author from Thailand examines the pathogenesis of renal dysfunction in leptospirosis. The utility of dopamine in this setting is contrasted with its effects in renal dysfunction of other etiologies.
It is estimated that up to 30% of people who regularly receive hemodialysis for kidney failure suffer from a depressive disorder. Depression can compromise treatment compliance, and modulate the immunological and nutritional status of patients. In this thorough and balanced overview, the authors explore this understudied issue, drawing attention to the problems associated with detection of depression and effective management in hemodialysis populations.
It is essential that community-based nephrologists and primary care physicians, who are increasingly involved in the management of stable renal allograft recipients, are familiar with new-generation immunosuppressive drugs. This comprehensive article by Arjang Djamali and colleagues is a guide to the pharmacokinetics, dosing, drug–drug interactions and adverse effects of the mainstays of modern immunosuppression; calcineurin inhibitors, antimetabolites, mTOR inhibitors and corticosteroids.
This Review integrates discussion of well-established mechanisms that are known to underlie the 'fetal origins hypothesis' of hypertension with examination of mechanisms for which data continue to emerge. Set in the context of implications for public health, the authors suggest that monitoring the blood pressure, renal function and body weight of at-risk children might help to reduce the likelihood of kidney and cardiovascular disease developing in later life.
There is a high false-positive rate for certain serologies in patients with HIV infection. Here, Hernandez and colleagues reinforce several salient points relating to the management of HIV-seropositive patients with renal disease. The case clearly highlights the importance of kidney biopsy; aggressive immunosuppressive therapy in the setting of HIV-infection should be avoided unless a diagnosis of autoimmune disease is confirmed.
