Volume 8 Issue 2, February 2012

Research into genetic susceptibilities for proteinuric glomerular diseases has uncovered key pathogenic contributions from inheritable defects in podocytes. However, much less is known about environmental factors that may initiate or propagate podocyte injury. Seminal reports in 2011 provided new mechanistic insights into how this may occur.

Understanding the complex interactions between the various pathways disrupted in polycystic kidney and liver disease is essential to identify and optimize therapies for these disorders. Studies published in the past year have demonstrated a functional interaction between the main proteins implicated in these diseases and identified novel therapeutic approaches.

Acute kidney injury (AKI) is a syndrome of decreased renal function that is associated with an increased risk of death. Studies from 2011, particularly in the field of AKI biomarkers, have provided important insights into the diagnosis, prognosis, and treatment of AKI. These advances are now being brought to the bedside to improve diagnosis and treatment of AKI.

In 2011, studies of chronic kidney disease (CKD) were published in abundance. The articles selected here represent the growing appreciation of the importance of CKD as a modifier of outcomes, breakthroughs in understanding the pathobiology and genetics of specific conditions, and clinical trials of treatment strategies that offer hope to patients with CKD.

More than 1.4 million patients are on renal replacement therapy worldwide. Mortality in patients with end-stage renal disease (ESRD) is as high as that seen in some types of metastatic cancer, and premature cardiovascular disease is the major killer in ESRD. Several publications in 2011 addressed how interventions can modify cardiovascular risk factors and improve outcomes.

The past year was marked by several excellent studies that represent important therapeutic advances in kidney transplantation or that further our understanding of the genetic basis of chronic allograft dysfunction, clinical tolerance and outcomes of kidney transplantation.

Infection is one of the most common causes of morbidity, mortality and hospitalization in patients undergoing dialysis. This Review focuses on the epidemiology and characteristics of access-related infections—bloodstream infections in hemodialysis and peritonitis in peritoneal dialysis—as well as access-unrelated infections, such as viral hepatitis and respiratory infection.

Genome-wide association studies (GWASs) have led to the identification of genes underlying renal traits such as glomerular filtration rate, and improved our understanding of the pathogenesis of chronic kidney disease. In this Review, O'Seaghdha and Fox discuss how GWASs have revolutionized genetic research, using several large-scale studies as examples, and explain how the knowledge derived from these studies can be applied to improve our understanding of the pathogenesis of kidney disease and to identify novel therapeutic targets.

Diuretics are commonly used in the treatment of patients with chronic kidney disease. However, many questions remain regarding this practice, such as how best to combine diuretics and whether loop diuretics can be used in patients on hemodialysis. In this Review, Dominic Sica addresses these and other important questions surrounding the use of diuretics in patients with renal disease.

Renal biopsy analysis remains the best method to establish the cause of acute or chronic kidney allograft dysfunction. In this Review, Winfred Williams and colleagues provide an overview of the utility of performing kidney graft biopsies after transplantation. The wide variety of pathological features that characterize the major clinical diagnoses facing the clinician are also discussed. The authors also provide insights into emerging technologies that might expand our knowledge of the mechanisms of allograft dysfunction and the development of precise treatment protocols.

Identification of effective therapies for nephrotic syndrome is challenging. The pituitary adrenocorticotropic hormone (ACTH) has been shown to be renoprotective in patients with proteinuric neuropathies, but its mechanism of action is unknown. In this Perspectives, Runjun Gong provides an overview of the biophysiology of ACTH, the effects of ACTH on proteinuric renal diseases and the mechanisms likely to be involved in its therapeutic activity. The potential therapeutic role of ACTH for nephrotic glomerulopathies is also discussed.