Volume 5 Issue 4, April 2009

At first glance, the findings of the ACCOMPLISH trial threaten to undermine the importance of diureticss in the arsenal of blood-pressure-lowering therapies. But closer examination reveals that the story is more complicated.

Urine microscopy is a time-honored, readily available and commonly used noninvasive test to aid clinicians in discriminating between different forms of acute kidney injury. However, the diagnostic and prognostic importance of assessing urinary sediment is largely unknown.

A recent meta-analysis concluded that plasma exchange is the most effective intervention for thrombotic thrombocytopenic purpura and that plasma manipulation offers no additional benefit over simple supportive therapy in hemolytic uremic syndrome. These findings must be interpreted with great caution, as response to treatment depends on the underlying disease etiology.

World Kidney Day 2009 was celebrated last month in more than 100 countries, and aimed to raise awareness that the symbiotic relationship between hypertension and kidney disease should be prevented.

Predicting outcomes of renal transplant recipients using standard statistical techniques is difficult. Novel approaches such as the use of artificial neural networks might improve the precision and accuracy in this area of medicine in which numerous and complex events contribute to outcomes.

Antibiotic treatment can lead to a wide spectrum of disturbances in the electrolyte and/or acid–base balance, despite a preserved glomerular filtration rate. This Review describes how each nephron segment is affected by antibiotic treatment and discusses the mechanisms that lead to disrupted renal tubular function. This insight should pave the way for pathophysiology-directed treatment of these disorders.

An orally active small-molecule inhibitor of plasminogen activator inhibitor 1 (PAI-1) could provide a novel therapeutic strategy for renal and cardiovascular diseases. Here, authors from Ewha Womans University, Seoul review current understanding of the role of PAI-1 in renal fibrosis and intimal hyperplasia, with a particular focus on the regulation of PAI-1 expression by reactive oxygen species. They also discuss the progress that has been made toward achieving therapeutic suppression of PAI-1.

Membranous nephropathy is an uncommon form of lupus nephritis, accounting for only one-fifth of all cases. As a result, few reviews have focused on this condition. Here, Chi Chiu Mok summarizes the histological classification, clinical presentation, outcomes and therapy of membranous lupus nephropathy. As the optimal therapy for this form of lupus nephritis remains unclear, the author provides an algorithm to help guide treatment.

This Review describes the cardiovascular manifestations of autosomal-dominant polycystic kidney disease (ADPKD), including hypertension, left ventricular hypertrophy, aneurysms and cardiac valvular disorders. The authors focus particularly on hypertension, with a detailed discussion of the pathogenesis of this condition in ADPKD and a comprehensive review of the renal and cardiovascular effects of antihypertensive treatment in the ADPKD setting. Recommendations for the optimal cardiovascular management of ADPKD are provided.

Children with end-stage renal disease (ESRD) have a more than 700-fold increased risk of cardiac death compared with healthy children of the same age. Here, pediatric nephrologists from the Netherlands describe the arterial and cardiac abnormalities that are responsible for this high cardiovascular burden, outline the risk factors for such abnormalities, and suggest strategies for their prevention. The need for prospective follow-up studies of cardiac risk factors in the pediatric ESRD setting is highlighted.

Kidney involvement can be a serious complication of hematopoietic stem cell transplantation. In this Case Study, Fofi and colleagues describe a rare case of focal segmental glomerulosclerosis occurring as a complication of chronic graft-versus-host disease following peripheral blood stem cell transplantation.