Volume 10 Issue 5, May 2014

Well-controlled oral anticoagulation lowers the risk of ischaemic stroke in patients with atrial fibrillation; however, conflicting evidence exists on its benefits and risks in patients with end-stage renal disease. Shah and colleagues examined this question in a large cohort of patients on dialysis who were diagnosed with atrial fibrillation.

Anti-CD20 therapy is increasingly being used in the treatment of various patterns of nephrotic syndrome in adults and children. However, its use is still based largely on observational studies and expert opinion. Well-designed randomized controlled trials are urgently needed to define the role of this expensive therapy.

Blood-oxygen-level-dependent MRI enables noninvasive assessment of renal deoxyhaemoglobin levels and, therefore, hypoxia. As decreased tissue oxygenation might contribute to acute and chronic kidney disease (CKD), this tool has been examined in patients with CKD. Indeed, the benefits of renin–angiotensin–aldosterone system inhibitors might be partly conferred by increased oxygenation.

Genome-wide analyses have identified a number of novel microRNAs (miRNAs) related to immunological and pathological changes in the kidney. In this Review, the authors describe the various purported roles of these miRNAs in IgA nephropathy, including in the aberrant glycosylation of IgA₁that has a central pathogenetic role in the early phase of this disease.

Chronic kidney disease (CKD) is becoming a worldwide epidemic, largely due to the increased prevalence of obesity and diabetes in the general population. As a consequence, new targets and treatments are urgently required to reduce the burden of CKD and the need for renal replacement therapy in affected patients. Here, the authors discuss new insights into the fibrotic and inflammatory pathways that lead to CKD and highlight novel targets for potential disease-arresting therapies.

High serum levels of phosphate and fibroblast growth factor (FGF)-23 are associated with an increased risk of adverse cardiovascular events. In this Review, the authors discuss experimental and epidemiological data that supports high levels of phosphate or FGF-23 as risk factors for cardiovascular events in patients with or without chronic kidney disease.

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by antiphospholipid antibodies and thrombotic events. The kidney is a major target organ of APS, which is often present in association with other autoimmune disorders. In this Review, Sciascia et al. discuss the broadening spectrum of renal events associated with APS and the different therapeutic approaches that might be required for effective treatment.

The discovery and clinical development of new drugs—particularly therapies for kidney diseases—is a lengthy and costly process. Here, the authors discuss the need for closer collaboration between academia, industry and regulatory authorities to enable novel, efficient strategies for preclinical and clinical drug development. They also describe the current Japanese framework implemented to facilitate such collaboration.