Volume 10 Issue 10, October 2014

Schreiber et al. have identified an unexpected immunoregulatory role of reactive oxygen species in antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis. Here, we discuss these findings in view of other pathways with well-known immunostimulatory roles in kidney disease that have recently been shown to have additional immunosuppressive effects.

The PREDIAN trial investigated the renoprotective effects of pentoxifylline, in addition to renin–angiotensin system blockade, in patients with type 2 diabetes mellitus and chronic kidney disease. This promising approach resulted in a reduction in the rate of decline in estimated glomerular filtration rate and a significant decrease in albuminuria.

The role of the innate immune system in mediating allograft rejection is unclear. A new study demonstrates for the first time the ability of allografts to stimulate the differentiation of monocytes into inflammatory dendritic cells, which produce IL-12 and stimulate T cells, leading to graft rejection.

Despite uncertainty in the KDIGO guidelines, new research has shown that they can accurately identify acute kidney injury in critically ill patients who have a high risk of mortality. Future refinements to AKI definitions will require biomarkers, and robust assessments in prospective studies.

Should poor-quality kidneys be allocated to elderly recipients? A new study has determined that kidney recipients aged ≥70 years have similar outcomes regardless of donor-organ quality, with the exception of the lowest-quintile quality organs. These data can help physicians advise their elderly patients to decide whether or not to accept a kidney offer.

Although vulnerable to infection, substantial numbers of kidney transplant recipients remain unvaccinated. This missed opportunity for protection can result in serious infection, graft loss and mortality. Here, Camille Kotton discusses the safety, efficacy, need for and timing of vaccination in adult transplant recipients, including discussion of specific vaccines and indications.

Nephritis is observed in around 30% of children with Henoch–Schönlein purpura (HSP). The treatment of these patients is complicated by similarity to IgA nephropathy. Here, the authors discuss advances in understanding of the pathophysiology, diagnosis and treatment of paediatric HSP nephritis. They suggest that current treatment guidelines based evidence obtained in adults with IgA nephropathy might be inappropriate for children with HSP nephritis.

Since the approval of deferasirox for patients with blood-transfusion-related iron overload by the FDA in 2005, >150,000 patient-years of exposure have occurred. However, nephrotoxicity is a common adverse effect of deferasirox therapy and the drug remains a medicine under additional monitoring status. Here, Díaz-García et al. review the clinical features, epidemiology and current understanding of the molecular mechanisms of deferasirox nephrotoxicity.

In the past decade, rodent models have proven critical to study the molecular basis and natural history of polycystic kidney disease. Here, the authors provide an update on the models used to investigate the molecular pathogenesis of autosomal dominant polycystic kidney disease (ADPKD) and test potential therapies. They also highlight progress that has been made in understanding the pathophysiology of ADPKD in humans.

Drug trial and approval processes are often affected by the conflicting interests of regulatory authorities, academia, and the pharmaceutical industry. In this Perspectives article, Silvio Garattini and Norberto Perico discuss examples of particular relevance to therapeutic interventions in nephrology, to highlight and summarize flaws in the current drug development process. The authors call on academia to develop more-effective relationships with both regulatory authorities and the pharmaceutical industry to balance public needs with commercial aims.