Volume 10 Issue 3, March 2014

'Chronic kidney disease (CKD) in older people' is the focus of World Kidney Day 2014. In this article, we discuss the key links between kidney function, age, health and illness, as well as the implications of the ageing population for the care of people with CKD.

T-lymphocyte activation antigen CD80 is a B-cell costimulator and podocyte injury marker originally described in lupus nephritis; CD80 blockade with abatacept disappointed in a lupus nephritis trial. A study now suggests abatacept efficacy in focal and segmental glomerulosclerosis. Small patient numbers and concurrent treatment regimens call for more definitive studies regarding this therapeutic strategy.

For most patients with end-stage renal disease (ESRD), a kidney transplant is the best treatment option. Compared with dialysis, a successful kidney transplant is associated with increased life expectancy and improved quality of life; a living donor transplant is associated with better long-term results than a deceased donor transplant.

A new haemodialysis catheter-care procedure has been reported, including exit-site disinfection with chlorhexidine gluconate that results in a sustained reduction in bacteraemia rates, new intravenous antibiotic starts and sepsis-associated and access-associated hospitalization rates compared with standard care. These findings have potential implications for the prevention of haemodialysis catheter-associated infections.

Fujii and colleagues define 'subacute' kidney injury (s-AKI) as AKI that takes >7 days to develop, timed from admission or lowest creatinine measurement after admission. Although s-AKI is unlikely to be a distinct syndrome from AKI, the association with increased mortality highlights the need to monitor patient creatinine levels.

In this Review, the authors describe the potential benefits of partial versus radical nephrectomy for small renal cell carcinomas. They also discuss the risk ofde novokidney disease or progression of pre-existing chronic kidney disease after nephrectomy, the potential factors that might influence patient prognosis after this surgery, and the need for further research in this field.

Blood pressure control is influenced by amiloride-sensitive sodium channels in the vascular and epithelial homeostatic systems in the kidney. Here, the authors describe the expression and regulation of sodium channels, and they outline the emerging evidence that differences between sodium channel complexes expressed in the epithelia and endothelia might permit novel therapeutic approaches to lower systemic blood pressure without the adverse effects associated with the sodium channel blockers that are currently available.

The glomerular parietal epithelial cell (PEC)—a resident glomerular cell type—has been under active study in recent years, improving the understanding and definition of how these cells behave normally and in glomerular disease. Here, the authors discuss model systems to study PECs, how PECs might contribute to glomerulosclerosis, crescent and pseudocrescent formation and how PECs handle filtered albumin.

Haemolytic uraemic syndrome (HUS) leads to anaemia, thrombocytopenia and, ultimately, acute renal failure. Some patients are also at risk of cardiovascular complications owing to mutations in the complement pathway, which result in microangiopathic injury of the coronary vasculature. This Perspectives article highlights the cardiovascular complications arising in patients with HUS and the implications for treatment of this rare disease.