Volume 13 Issue 8, August 2017

New data highlight the increasing global burden of cardiovascular disease, end-stage renal disease and disability adjusted life years that can be attributed to reduced glomerular filtration rate (GFR). These findings underline the need to evaluate whether screening for chronic kidney disease is effective and if early interventions can reduce the incidence of GFR-attributable adverse events.

Mechanistic studies have implicated the alternative complement pathway, specifically C5a receptor activation, in the pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis. Results from a phase 2 trial suggest that C5a receptor blockade could enable the reduced use or complete withdrawal of steroids from induction protocols.

The FOURIER trial shows that evolocumab, an injectable monoclonal antibody against PCSK9, decreased the risk of cardiovascular events in high-risk patients receiving statin therapy. The beneficial effects of this drug were consistent with an absolute reduction in LDL cholesterol levels, although studies with a longer follow-up period are needed.

Immunomodulatory treatment with mesenchymal stromal cells represents a novel therapeutic modality for immune-mediated kidney injury, including in the settings of renal transplantation and glomerulonephritis. A new study illustrates the complexity of aligning clinical trial design, manufacturing and availability of biomarkers in order to turn this promising concept into a therapeutic reality.

Dysfunction of endolysosomal pathways can lead to generalized dysfunction of the proximal tubule. Here, De Matteis and colleagues describe the role of the inositol polyphosphate 5-phosphatase, OCRL, in the endolysosomal pathway and how mutations in the encoding gene lead to the clinical manifestations of Lowe syndrome and Dent disease 2.

Epigenetic factors control gene expression and activity in response to environmental perturbation and regulate ageing processes throughout the life course. Here, the authors discuss the epigenetic regulation of signalling pathways that modulate ageing and their impact on the kidney.

Current treatment recommendations for lupus nephritis are largely guided by the 2003 International Society of Nephrology/Renal Pathology Society classification system. Here, the authors discuss potential approaches by which this classification system could be improved through consideration of underlying disease processes characterized by the presence of glomerular crescents, podocyte injury, tubulointerstitial lesions and vascular injury.

This Review provides an overview of the molecular determinants of renal cell carcinoma, how understanding the underlying mechanisms of disease has fuelled the development of targeted therapies, and tools to assess the value of these agents.