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The ASCEND study was a large, international trial that aimed to assess the effects of avosentan on diabetic nephropathy. To the disappointment of the nephrology community who had anticipated that the trial would demonstrate beneficial effects of this treatment, ASCEND was terminated early owing to excessive rates of adverse events, such as congestive heart failure associated with avosentan use.
Individuals with chronic kidney disease (CKD) are more likely to die of cardiovascular causes than progress to end-stage renal disease. A recent report on a large, contemporary cohort highlights the high rates of CKD among patients with acute coronary syndromes, the poor outcomes associated with CKD, and the ongoing gap between evidence and practice in this population.
Cardiovascular disease is the most frequent cause of death in patients on peritoneal dialysis. In this Review, Krediet and Balafa describe cardiovascular risk factors that may affect the general population, those that are related to end-stage renal disease, and those that are specific to patients on peritoneal dialysis. The authors also discuss how these factors may be modified by changes in residual kidney function and/or peritoneal dialysis.
Acute interstitial nephritis (AIN) is a common cause of acute kidney injury. The most common etiology of AIN is drug-induced disease, which results from a reaction to certain medications. Multiple classes of drugs can induce AIN, resulting in a range of clinical presentations and laboratory findings. This Review describes the clinical features of drug-induced AIN, with a particular focus on the different features that are induced by different agents. The pathology, diagnosis and management of drug-induced AIN are also discussed.
Cognitive impairment, delirium and depression are common in patients with renal disease. As all of these conditions are associated with prolonged hospitalization and an increased risk of mortality, a good understanding of these conditions is key to their prevention, early intervention and management. In this Review, McQuillan and Jassal summarize the main clinical features of the neuropsychiatric complications that occur in individuals with renal disease and describe the evidence for the high burden of neuropsychiatric disease in such patients.
Gastrointestinal complications commonly occur in patients with renal failure. Upper gastrointestinal lesions, gastrointestinal bleeding, pancreatitis, and ischemic colitis are more common in patients with renal failure than in the general population. This Review describes the prevalence, etiologies, and treatment of the most common gastrointestinal complications associated with renal failure. The renal consequences of common gastrointestinal procedures are also discussed.
Several distinct pathological patterns of glomerular disorders are associated with abnormal regulation of the complement system. Some of these conditions are characterized by glomerular deposits of complement C3 in the absence or in the presence of marginal deposits of immunoglobulin. In this Perspectives article, the authors suggest that glomerular pathologies where isolated complement C3 deposition is found should be classified by the term 'C3 glomerulopathy'.
