Volume 8 Issue 6, June 2012

An observational study associates azithromycin use with accelerated stool decolonization in patients infected with Shiga toxin-producing Escherichia coli O104:H4. Even if this association is causal, however, the value of late-in-illness treatment is not established and the results provide no support for early-in-illness treatment of Shiga toxin-producing E. coli infections.

Two recent studies have investigated the prevalence of anti-hLAMP-2 antibodies in patients with antineutrophil cytoplasmic antibody-associated vasculitides. Results from these studies suggest that more work is needed to standardize the assays used to detect anti-hLAMP-2 antibodies in patient sera before we can estimate their true prevalence in different patient populations and assess their potential clinical utility.

Increased urinary excretion of albumin and creatinine is associated with renal and cardiovascular events. Should the urinary albumin-to-creatinine ratio be considered a combination of two independent risk markers, or is it simply an easy way to obtain the same prognostic information as from a 24 h urine collection?

A recent report suggests that the incidence of acute kidney injury (AKI) in patients with acute myocardial infarction declined between 2000 and 2008 and was associated with decreased mortality despite concurrent increases in comorbidities. Although encouraging, changing patterns of care and an understanding of factors contributing to AKI in this setting must be considered.

Sudden death is very common in patients on dialysis, and identifying factors that may lower the risk of sudden death could improve survival of these patients. A recent international comparison of sudden death rates by Jadoul and colleagues gives us insight into how our clinical practice might affect rates of sudden death in dialysis patients.

The number of candidates awaiting kidney transplantation has grown substantially over the past few decades, but the number of available organs has increased only modestly. Barring any notable progress in technology, improving the fate of transplant candidates will rely heavily on increasing the pool of available donor organs. This Review outlines prominent proposed interventions that may increase the deceased kidney donor pool and discusses issues concerning their implementation and effectiveness.

Live donor kidney transplantation has decreased over the past few years and innovative strategies are needed to increase the donor pool. In this Review, Dorry Segev discusses recent clinical innovations that minimize the barrier to donation, including changes in surgical technique, kidney paired donation, incompatible transplantation as well as educational and outreach programs.

Optimizing kidney preservation is a primary concern in transplantation, particularly in relation to new donor sources, such as expanded criteria donors and donation after cardiac death. Here, the authors describe emerging strategies to prevent ischemia–reperfusion injuries in donor kidneys and describe innovative interventions at the donor, graft preservation or recipient levels to improve recovery, evaluation and outcome of kidney grafts.

Although outcomes of renal transplantation have improved in recent times, kidney allograft loss remains substantial. A major advance of the past decade has been the demonstration of the destructive power of anti-HLA alloantibodies and their association with antibody-mediated rejection (ABMR). The authors of this Review present the new entities and concepts that have emerged to expand our knowledge of the spectrum of ABMR and some aspects of the natural history of antibody-mediated kidney allograft deterioration.

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism was formulated at an international meeting held in 2008 with the aim of promoting the welfare of living organ donors in the context of improved global organ transplantation practice. In this Perspectives article, Danovitch and Al-Mousawi provide an update on this endeavor, specifically discussing promulgation of the Declaration, how it has been put into action and legislative changes that have since come into effect.

A growing body of evidence indicates that monocytes, specifically intermediate (CD14⁺⁺CD16⁺) monocytes, contribute to the development of atherogenesis and increase in number with worsening renal function. In this Review, Heine and colleagues on behalf of the EURECA-m working group of the ERA–EDTA, describe the developmental and functional characterization of monocyte subsets, with particular focus on prominent subsets in atherosclerosis and chronic kidney disease.

Renal transplantation improves both the length and quality of life of patients with end-stage renal disease. Demand for kidneys far outstrips the supply, however, and many other challenges remain in this field. This Focus issue of Nature Reviews Nephrologyincludes specially commissioned articles that look at these challenges, covering the topics of preservation solutions, ways to increase the pool of deceased donor organs, innovative strategies in living donor transplantation, the role of anti-HLA antibodies in late kidney allograft failure, and an update on the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.