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A Dutch study has evaluated the outcomes after transplantation of kidneys from pediatric patients after cardiac death. Such programs instigate ethical debate regarding the classification of donors, and raise questions about the suitability of protocols for determining when an individual can be declared dead, and thus, can donate their organs.
The survival advantages associated with renal replacement therapy might be counterbalanced by its negative effects on quality of life. Cohen et al. have proposed a simple mortality prediction model to help physicians discuss prognosis and individualized palliative care with patients on maintenance hemodialysis, to enable patients and their families make informed treatment decisions.
Acute kidney injury seems to have sequelae long beyond the index hospitalization. A new study suggests that even after adjusting for the impact of subsequent chronic kidney disease, acute kidney injury is associated with an increased risk of death.
A new comorbidity index predicts the risk of mortality in patients with end-stage renal disease (ESRD). This index, which was developed using data from a large US database, is an important tool for observational research in patients with ESRD, but its value in patient populations other than dialysis populations in the US needs to be validated.
Data are lacking on the impact of acute kidney injury (AKI) in children admitted to an intensive care unit. Schneider and colleagues have now performed a large-scale assessment of the use of the RIFLE criteria for characterizing AKI in children and have determined the mortality and morbidity associated with AKI in this patient group.
Liver disease can negatively affect clinical outcomes of patients with chronic kidney disease and patients who have undergone renal transplantation. Hepatitis B virus and hepatitis C virus infections are the most common form of liver disease in such patients. In this article, Fabrizi and colleagues discuss the natural history, clinical course, diagnosis and management of liver disorders associated with hepatitis B virus and hepatitis C virus infection in patients with chronic kidney disease and in renal transplant recipients, and also briefly describe other causes of liver disease in such patients.
The endothelium has a central role in the development of kidney disease and vascular lesions. In this Review, Ton Rabelink and colleagues discuss the biology of endothelial activation at a molecular level and the relevance of this process in the context of clinical outcomes. The authors also discuss markers of endothelial injury and repair in patients with renal disease and the potential for these markers to improve patient care.
New-onset diabetes after transplantation (NODAT) is a common complication following kidney transplantation and is associated with adverse patient and graft outcomes. This Review discusses the current understanding of the risk factors associated with NODAT and transplant-associated hyperglycemia. The authors suggest that a dynamic approach to the surveillance and attenuation of transplantation-associated hyperglycemia may help to improve the outcomes of patients with NODAT.
Cystinuria is an inherited disease characterized by the failure to reabsorb filtered cystine and dibasic amino acids in the proximal tubule that leads to the formation of cystine stones. In this Review, Chillarón and colleagues discuss the genetic mutations that lead to cystinuria, the molecular mechanisms by which some of these mutations may cause the disease, and the current and prospective treatment options for recurrent cystine lithiasis.
This article reports the case of a 62-year-old man with end-stage renal disease on continued ambulatory peritoneal dialysis who presented with epigastric pain. Physical examination, imaging of the abdomen and cultures of peritoneal dialysis fluid led to a diagnosis of rare, fungal peritonitis caused byHistoplasma capsulatum. Removal of the peritoneal catheter and a switch to hemodialysis led to resolution of the patient's symptoms.
