Volume 8 Issue 8, August 2012

A defect in urine-concentrating ability is discernable in patients with autosomal dominant polycystic kidney disease (ADPKD) before any decline in glomerular filtration rate, and is associated with elevated concentrations of vasopressin and copeptin. This defect is 'urea-selective' and accordingly, the urine-to-plasma ratio of urea concentration could be a clinically relevant early marker of renal dysfunction in patients with ADPKD.

Previous studies have indicated that ablation of renal sympathetic nerves reduces blood pressure in patients with resistant hypertension and preserved renal function. Hering et al. have now investigated the efficacy and safety of this procedure in patients with moderate to severe chronic kidney disease.

The use of statins as a line of primary prevention in individuals at low risk of cardiovascular events is an area of debate. The most recent meta-analysis from the Cholesterol Treatment Trialists' (CTT) Collaboration suggests that present guidelines for prescribing statin therapy may need to be reconsidered.

In a new study, Porcheray et al. provide evidence that a single antibody generated by alloimmunization can recognize multiple antigens in a paradigm-changing fashion. Although these results require confirmation, the presence of polyreactive antibody may offer an explanation as to why some patients with a single sensitizing event develop a wide breadth of panel-reactive antibody.

Although children with Wilms tumor now have excellent survival rates, some develop end-stage renal disease (ESRD) owing to immediate nephrectomy or later loss of renal function. According to current recommendations, renal transplantation should be delayed for 2 years following Wilms tumor treatment in children, but data from the National Wilms Tumor Study now question such a waiting period.

Corticosteroids have been used to treat childhood nephrotic syndrome for more than 50 years but a minority of patients, especially those with focal segmental glomerulosclerosis, are resistant to this treatment, This Review summarizes the currently available treatments for both steroid-sensitive and steroid-resistant childhood nephrotic syndrome, and discusses selected novel pathways in podocytes that could be targeted for the development of next-generation treatments for children with this syndrome.

Inverse associations between bone mineral density and calcified atherosclerotic plaque are observed in individuals of European and African ancestry without nephropathy, suggesting a mechanistic link between these processes that is independent of kidney disease. Here, the authors discuss genetic and mechanistic approaches used to explore these differences, and explain how these findings could further our understanding of bone–blood vessel relationships.

The autosomal–recessive inherited primary hyperoxalurias are rare but devastating diseases caused by defects in glyoxylate metabolism that lead to the endogenous overproduction of oxalate. In this Review, Bernd Hoppe describes the clinical appearance and diagnosis of the three different forms of primary hyperoxaluria, and discusses the available and future treatment options.

The antithyroid drug propylthiouracil has been recognized to cause antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This disease shares some characteristics with primary AAV although important differences do exist. The authors of this Review discuss the pathogenesis, risk factors, diagnosis and treatment of propylthiouracil-induced AAV and also outline the similarities and differences between propylthiouracil-induced AAV and primary AAV.

Fibroblast growth factor 23 (FGF23) is a hormone involved in bone and mineral metabolism. Increased FGF23 levels are associated with poor clinical outcomes in patients with kidney disease and could represent a novel biomarker and therapeutic target. In this article, Komaba and Fukagawa provide an overview of the physiological role of FGF23 and discuss the Klotho-dependent and Klotho-independent effects of FGF23 in disease.