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Blockade of the renin–angiotensin system does not seem to prevent early nephropathy in individuals with type 1 diabetes who are normoalbuminuric and normotensive, but both the angiotensin-converting-enzyme inhibitor enalapril and the angiotensin-receptor blocker losartan seem to retard retinopathy.
Primary hyperoxaluria eventually leads to end-stage renal disease and systemic oxalosis; if left untreated, it may be fatal. The outcome might be different if primary hyperoxaluria is diagnosed early, but when is 'early'?
Small-scale clinical trials have provided encouraging evidence on the short-term orexigenic effects of subcutaneous ghrelin administration in malnourished dialysis patients. New treatment strategies to tackle the excess mortality of this patient group are urgently needed, but the strengths, shortcomings and unanswered questions related to ghrelin treatment need to be highlighted.
The automated reporting of estimated glomerular filtration rate has increased the number of patients being referred to nephrologists, but is chronic kidney disease being incorrectly diagnosed in individuals who have normal serum creatinine levels?
The degree to which systolic blood pressure should be lowered in individuals with mild hypertension is unclear. The Cardio-Sis trial has investigated whether tight systolic blood pressure control is more beneficial than usual control in individuals with hypertension but without diabetes.
Chronic kidney disease (CKD) is a common condition and its prevalence is increasing. Prognosis is poor, with many patients experiencing disease progression. Recognizing the factors associated with CKD progression would enable high-risk patients to be identified and given more intensive treatment if necessary. The identification of new predictive markers might improve our understanding of the pathogenesis and progression of CKD. Here, Florian Kronenberg discusses various emerging factors and markers for which epidemiological evidence from prospective studies has shown an association with CKD progression.
Vitamin D has long been understood to be a key player in the control of bone metabolism through the regulation of calcium and phosphate homeostasis; however, growing evidence suggests this hormone may also have an important role in the progressive loss of renal function. In this Review, the authors discuss the pathogenic consequence of vitamin D deficiency on the kidney and describe the renoprotective potential of vitamin D analogues for patients with kidney disease.
Proteomic research has the potential to provide disease biomarkers to clinical practice and insight into pathological mechanisms. In this Review, Welberry Smith and colleagues present an overview of the state of the art of proteomic analysis applied to the study of kidney diseases and discuss future directions of this research field and likely developments.
According to the 'lipid nephrotoxicity hypothesis', hyperlipidemia resulting from physiological compensatory synthesis of lipoproteins in response to urinary loss of albumin can itself cause or aggravate glomerular and tubulointerstitial disease. Ruan and colleagues discuss the evidence on the mutual influence that dysregulation of lipid homeostasis and renal disease exert on each other and how such evidence confirms, qualifies and modifies the lipid nephrotoxicity hypothesis.
This article considers the case of a 25-year-old woman with a medical history notable for joint laxity and hypermobility syndrome. She had recurrent episodes of severe, right-sided abdominal and flank discomfort, intermittent gross hematuria, and sensation of a mass on her right side. Intravenous pyelography led to a diagnosis of nephroptosis.
