Volume 8 Issue 7, July 2012

Can treatment delay end-stage renal disease in children with Alport syndrome? New guidelines have been provided based on our ability to identify individuals at risk of early-onset renal failure and on evidence for blockade of the renin–angiotensin system that has been derived from Alport patient registries, other renal diseases and animal studies.

Cardiovascular events in patients with diabetes and no history of cardiovascular disease (CVD) are associated with albuminuria rather than kidney disease stage, according to a recent study. Reducing albuminuria, therefore, seems to benefit patients with diabetes but the underlying question still remains—is albuminuria a marker or mediator of CVD?

The RASCAD trial investigated the potential benefit of renal artery revascularization versus medical therapy in patients with renal artery stenosis and coronary artery disease. Surprisingly, renal artery stenting seemed to convey no benefit on left ventricular mass. Has all been said and done about renal artery revascularization?

A comparison by Selistre et al. of several creatinine-based equations commonly used to estimate glomerular filtration rate (GFR) shows that equations developed in adult populations result in substantial overestimation of GFR in adolescents and young adults. Equations developed in pediatric populations were found to have superior performance, but limitations remain for all estimates.

Concern exists that a sizeable proportion of patients with chronic kidney disease are not adequately prepared for initiating dialysis therapy. In this Review, members of the Dialysis Advisory Group of the American Society of Nephrology discuss the challenges in preparing patients for dialysis therapy and present a practical step-by-step approach to help transition patients to renal replacement therapy.

Polyomavirus-associated nephropathy (PVAN) is an important infectious complication after renal transplantation, affecting 1–10% of recipients and causing graft loss in approximately 50% of cases. This Review discusses new insights into BK virus biology and PVAN development, and describes diagnostic approaches for the detection, surveillance and therapeutic monitoring of BK virus. In addition, the author reviews strategies for reducing immunosuppression and discusses current and future prospects for specific antiviral drug development.

Vitamin D has an important role in regulating the innate and adaptive immune response. Patients with kidney disease are often deficient in vitamin D, which could partly explain the high morbidity and mortality associated with infection that is commonly seen in these patients. In this Review, Sterling et al. describe the pleiotropic actions of vitamin D on the immune system and how vitamin D deficiency leads to immune dysfunction.

Hypertension is a global health challenge that is associated with increased morbidity and mortality. Modification of dietary factors such as sodium, potassium and protein has potential to reduce blood pressure, attenuate the rise in blood pressure with age, and improve the efficacy of antihypertensive therapy. The authors of this Review discuss various dietary approaches that have been shown to modify blood pressure and improve outcomes.

Klotho deficiency is now considered an early event in acute kidney injury (AKI), and a pathogenic factor that contributes to kidney damage. Here, the authors discuss why this renal-derived protein is a highly promising candidate as both an early biomarker and therapeutic agent for AKI.