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In response to data from trials showing an increase in clinical events with the use of erythropoiesis-stimulating agents (ESAs), Seliger et al. carried out an observational case–control study and have found that high doses of ESAs are associated with an increased risk of stroke.
In the CKiD study, extracellular fluid volume (ECV) was estimated from plasma iohexol curves in children with chronic kidney disease. A simple formula for ECV that uses weight and height data has now been derived. No relationship existed between weight-normalized ECV and hypertension, suggesting that volume overload does not underlie hypertension in this population.
Protein-energy wasting (PEW), manifested by low serum levels of albumin and weight loss, is common in patients with chronic kidney disease (CKD) and is a strong predictor of mortality. The authors of this Review discuss the evidence indicating that dietary interventions and nutritional support can mitigate PEW and improve outcomes in patients with CKD. They also describe how in-center meals and oral supplements during dialysis may improve survival and quality of life in this group of patients.
Inflammation is highly prevalent in patients with chronic kidney disease (CKD) and is associated with increased mortality and cardiovascular events. Besides reducing lipid levels, statins have anti-inflammatory effects that are modified by the presence of inflammation, making these agents especially effective in patients with CKD who show evidence of inflammation and raised levels of C-reactive protein. In this Review, Krane and Wanner provide an overview of statin studies in patients with CKD, and discuss how the results could influence clinical decision making.
Reactivation of latent BK polyomavirus (BKV) infection is a major challenge in renal graft recipients and progression of BKV infection to BKV-associated nephropathy (BKVAN) leads to graft loss in up to 60% of affected patients. This Review discusses the available data on the diagnosis and monitoring of BKV infection and BKVAN, describes the known risk factors for BKV-related disease, and reviews current approaches to treatment and prevention of both BKV infection and BKVAN.
Gene silencing using small interfering RNA (siRNA) molecules is a promising therapeutic strategy for renal diseases, but many practical challenges hinder their clinical application. The authors of this Review provide a comprehensive overview of the current status of siRNA-based therapies for glomerulonephritis, and discuss current and future delivery systems for these agents.
Extensive rhabdomyolysis is often lethal unless treated immediately, owing to hypovolemic shock, hyperkalemia, acidosis and myoglobinuric acute kidney injury. In patients with rhabdomyolysis caused by muscle crush syndrome, the use of early fluid resuscitation at the scene of injury has reduced mortality from ∼100% to <20% over the past 70 years. In this article, Better and Abassi discuss the lifesaving and limb-saving potential of early vigorous fluid resuscitation in patients with extensive traumatic and nontraumatic rhabdomyolysis.