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Poor glycemic control is considered harmful in people with diabetes and chronic kidney disease; however, the ideal hemoglobin A1c target continues to be elusive. What can we learn from new observational evidence published by Shurraw et al. in the Archives of Internal Medicine?
A report has suggested a J-shaped association between estimated sodium excretion and cardiovascular risk. However, because spot urinary sodium does not reflect daily salt intake, the results from this study do not change the strong evidence showing that a modest reduction in salt intake has major beneficial effects on health.
Maintenance immunosuppressive drug therapy is necessary to counter the propensity of lupus nephritis to relapse. Claims that mycophenolate mofetil might be the magic bullet for both induction and maintenance therapies merit critical reappraisal due to inconsistent evidence of the superiority of mycophenolate mofetil over azathioprine, as well as its inordinately greater cost.
World Kidney Day on March 8, 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end-stage renal disease that surpasses dialysis treatments in terms of cost-effectiveness and improving quality and length of life.
Biomarkers have the potential to refine prognosis, improve risk stratification and guide therapy in patients on hemodialysis. The authors of this Review discuss the validation and potential use of biomarkers, including markers of chronic kidney disease-related mineral and bone disorders, markers of protein–energy wasting and inflammation, and markers of cardiovascular disease, in patients on hemodialysis. The authors also describe how proteomics can be used to identify and study new biomarkers.
Urolithiasis is a common disorder that has several metabolic risk factors, most notably hypercalciuria. Genetic variants associated with urolithiasis have been identified from linkage and candidate gene studies, as well as from the first genome-wide association study of this condition, highlighting the role of several proteins in disease development and progression. In this Review, Monico and Milliner summarize the findings from studies that have advanced the understanding of the genetic basis of urolithiasis.
Protein–energy wasting (PEW) is an important risk factor for morbidity and mortality in patients on dialysis. Improving the poor nutritional status of patients with PEW on peritoneal dialysis is difficult owing to the multifactorial and complicated pathogenesis of PEW. This Review summarizes the nutritional issues regarding the causes, assessment and treatment of PEW, with a focus on patients receiving peritoneal dialysis.
Xerostomia is a common symptom in patients on chronic hemodialysis and is associated with a number of important clinical consequences that can have adverse effects on patients' daily activities and on the success of hemodialysis treatment. In this Review, Bossola and Tazza discuss the prevalence, pathogenesis, outcomes and available treatment options for this trying symptom.
Lupus nephritis is a complication of systemic lupus erythematosus, a heterogeneous autoimmune syndrome that involves multiple pathogenetic pathways. Here, Adriana Migliorini and Hans-Joachim Anders summarize accumulating data from the fields of genetics, clinical science, transcriptomics and basic immunology which indicate that antiviral immunity is involved in the pathogenesis of lupus nephritis. The authors also discuss the potential implications for innovative therapeutic strategies.
