Volume 5 Issue 3, March 2009

Lower blood concentrations of protein-bound solutes have been directly linked to better outcomes in patients on dialysis. Studies indicate that clearance of protein-bound solutes is more efficient in patients on hemodialysis than in those on peritoneal dialysis; however, paradoxically, the circulating levels of these solutes are lower in patients on peritoneal dialysis. Vanholder and colleagues consider possible explanations for this discrepancy, such as differences in intestinal generation or metabolism of these molecules.

Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive medication in transplantation for over a decade. Because of its efficacy and relatively benign adverse effect profile, MMF's use has been investigated in the treatment of a number of glomerular diseases. This Review focuses on the major trials of MMF in lupus nephritis and other primary glomerulopathies including minimal-change disease, focal segmental glomerulosclerosis, membranous nephropathy and IgA nephropathy.

Tuberous sclerosis complex and von Hippel–Lindau disease are distinct autosomal dominant tumor suppressor syndromes that are characterized by solid and cystic renal lesions. The products of the affected genes are linked in an intricate pathway that regulates cell growth, proliferation, and vascular supply. This Review examines the phenotypic overlap between the diseases in the context of their pathophysiologic similarities, outlines the optimal management of both conditions, and highlights promising future pharmacologic interventions.

Skin disorders are very common in patients with chronic kidney disease and can seriously affect their mental and physical health. Although the majority of the disorders are relatively benign, some can cause serious morbidity and mortality. Early recognition of these severe skin disorders and prompt initiation of treatment can dramatically alter their course and even save a patient's life. This Review discusses characteristics, pathophysiology and treatment of uremic pruritus, calcific uremic arteriolopathy and nephrogenic systemic fibrosis, and briefly describes acquired perforating dermatosis (Kyrle disease) and porphyria cutanea tarda.

Authors from the University of Colorado describe a 31-year-old white female with tuberous sclerosis complex who was diagnosed with very large bilateral angiomyolipoma of the kidneys after developing symptoms of urinary tract infection and septic shock. The lack of surveillance throughout the course of the patient's disease prevented early intervention before the development of end-stage renal disease and the need for bilateral nephrectomy. This case illustrates the importance of regular follow-up in patients with tuberous sclerosis complex.