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Major efforts are underway to expand the available pool of organ donors and increase the supply of transplantable kidneys to shorten transplant waiting lists for patients with end-stage renal disease (ESRD). Snoeijs et al. now report that kidneys from donors after cardiac death improve survival of patients with ESRD who are on a transplant waiting list.
Available evidence suggests that rituximab may be safe and effective for the treatment of refractory antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Two studies now show that rituximab is not less effective than cyclophosphamide for treating ANCA-associated vasculitides. Should rituximab be the new standard of care for patients with ANCA-associated vasculitis?
Several randomized clinical trials with short-term follow-up have shown that patients on hemodialysis with prophylactic antibiotic catheter locks have reduced catheter-related bacteremia. However, the long-term safety of such locks remains a subject of ongoing debate. Landry et al. now report that prophylactic gentamicin catheter locks can promote the emergence of gentamicin-resistant bacteremia during long-term use.
Hypertension is a chronic disease that can lead to the development of chronic kidney disease (CKD) or exist as a comorbidity of CKD, and can contribute to disease progression. In this Review, Udani and colleagues discuss the pathogenesis, prevalence and epidemiology of hypertension associated with CKD. Major factors in the diagnosis and treatment of CKD-associated hypertension are also described.
Postrenal transplant hemolytic uremic syndrome (HUS) can occur as a recurrent orde novodisease. Improved understanding of the mechanisms by which atypical HUS occurs after transplantation should result in the improved management of affected patients. In this Review, Zuber and colleagues discuss recent advances in our understanding of the pathogenesis of atypical HUS and describe diagnostic and therapeutic considerations with regard to renal transplantation in these patients.
Diabetic nephropathy and retinopathy are serious complications of diabetes, but the mechanisms involved in the progression of these entities are unknown. In this Review, Nakagawa and colleagues discuss clinical and experimental evidence, especially data from mouse models of diabetes, supporting endothelial nitric oxide deficiency and endothelial dysfunction as key factors in the development of diabetic nephropathy and retinopathy. The effectiveness of agents that target the renin–angiotensin system as treatments for diabetic nephropathy is also discussed.
Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease and atherosclerosis. In this Review, Kon and colleagues discuss CKD-induced atherosclerosis, with a particular focus on the experimental and clinical findings that support a key role for macrophages in atherogenesis. The authors describe how CKD can affect macrophage accumulation and function, including the roles of lipid, lipoprotein handling and angiotensin II in these processes.
This article reports the case of a 57-year-old woman who was diagnosed with primary aldosteronism after renal transplantation. The authors discuss the challenges of diagnosing this syndrome in patients with chronic kidney disease, the importance of identifying this condition owing to its association with cardiovascular risk and renal function impairment, and available treatment options.
