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Use of ABO-incompatible renal transplants from living donors has proven a viable and practical transplantation strategy. The protocols devised through the Johns Hopkins Incompatible Kidney Transplant Program could result in the most rapid escalation of access to organs in the modern era of transplantation.
Although ALMS, the largest prospective, randomized, controlled study comparing mycophenolate mofetil to intravenous cyclophosphamide for the initial treatment of severe lupus nephritis, failed to achieve its primary end point of mycophenolate superiority, mycophenolate plus corticosteroids has become the accepted standard of care. Are we really beyond cyclophosphamide for severe lupus nephritis?
Identifying patients at risk of end-stage renal disease relying only on measurement of both glomerular filtration rate and albuminuria could greatly decrease the number of patients flagged for renal surveillance without increasing the risk of overlooking high-risk individuals.
Two recent reports in the American Journal of Transplantation focus on the maternal and fetal outcomes of pregnancies in kidney donors and provide tantalizing, if somewhat worrisome, observations. The findings also leave us with several important unanswered questions.
Two observational studies report opposite effects of glitazones on clinical outcomes in patients with ESRD. Given the limited reliability of such studies in the assessment of moderate effects of treatment, however, findings in these articles should prompt the generation of hypotheses rather than dictate changes in clinical practice.
Defining the dose of a new renoprotective drug with the optimal benefit-to-risk ratio is an important consideration for drug developers and physicians. Have we learned from past experiences?
Heparin-induced thrombocytopenia (HIT) is a clinicopathologic syndrome in which one or more clinical events, usually thrombocytopenia or thrombosis, are temporally related to heparin administration and caused by HIT antibodies. This Review examines HIT from a renal perspective, discussing manifestations of HIT in patients on renal replacement therapy, the recent association of HIT with increased mortality in hemodialysis patients, newer aspects of HIT treatment in the renal patient, and heparin rechallenge in individuals who revert to antibody-negative status.
The term 'chronic allograft nephropathy' describes a clinical syndrome of proteinuria, hypertension and declining renal function, that is a major cause of late graft loss in renal transplant recipients. In this concise Review, authors from Korea discuss the contribution of immunological and non-immunological factors to the pathogenesis of chronic allograft nephropathy. In the absence of a definitive treatment protocol for the condition, they offer recommendations to minimize some of these underlying risk factors.
No large randomized, placebo-controlled trials have investigated whether the metabolic syndrome affects hard renal outcomes. In this Review, Varun Agrawal and colleagues evaluate the evidence of an association between the metabolic syndrome and chronic kidney disease and examine whether treatment of the syndrome improves renal outcomes. The authors conclude their discussion detailing the challenges of defining the metabolic syndrome and of selecting appropriate renal outcomes.
In this Review, Schurman and Scheinman detail the clinical and genetic features of syndromes with a defined genetic basis that are characterized by the concomitant presence of abnormalities of the central nervous system and kidneys. The authors focus their attention on the oculocerebrorenal syndrome of Lowe and on ciliopathies—particularly Joubert syndrome and Bardet–Biedl syndrome.
Calcific uremic arteriolopathy (CUA), a condition associated with high mortality, is most common among patients on dialysis. In this opinion article, Georg Schlieper and his colleagues discuss the evidence on the efficacy of administering sodium thiosulfate in the treatment of CUA. Given the lack of large clinical trials, the authors also evaluate the consultation of internet-accessible CUA case registries as a strategy to inform the treatment of this disease and to design future studies.
