Volume 2 Issue 4, April 2006

Selective cyclo-oxygenase 2 inhibitors (coxibs) were designed to provide effective analgesia without the gastrointestinal toxicity of classical, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). Concern has arisen, however, about the cardiovascular and renal safety of coxibs. In this Viewpoint, Matthias Hermann and Thomas F Lüscher examine the differences among these agents in their effects on sodium excretion, glomerular filtration rate and blood pressure, and provide their overall recommendation for use of these agents.

Although renal dysfunction can have a profound effect on the pathogenesis of cardiovascular disease, current guidelines for the management of hyperlipidemia in patients with chronic kidney disease (CKD) were formulated in the absence of data on cardiovascular and cerebrovascular outcomes in this population. Considering the individual stages of CKD, authors from the University of Würzburg, Germany, analyze data from the 4D trial and other studies, and attempt to answer the question of when hyperlipidemia should (or should not) be treated in patients with CKD.

Primary aldosteronism is found in about one-tenth of people with hypertension. Following diagnosis, effective treatment is based on identification of the specific subtype of this condition. Of the various causes underlying primary aldosteronism, bilateral idiopathic hyperplasia and aldosterone-producing adenoma are the most common. In this Review, the authors describe the optimal approaches to detection and management of subtypes of aldosterone hypersecretion.

Production of nitric oxide (NO) is reduced in chronic kidney disease and end-stage renal disease. Data support the conclusion that low NO levels, probably a function of perturbed endothelial synthesis, contribute to progressive kidney dysfunction. Chris Baylis outlines the mechanisms by which NO deficiency can develop in renal disease states, and discusses the potential for developing new treatments by manipulating NO biosynthetic pathways.

Introduced in the late 1990s for non-Hodgkin's lymphoma, the anti-CD20 monoclonal antibody rituximab has had anecdotal success in several renal settings. Here, Salama and Pusey compile and evaluate the data supporting use of rituximab to manage post-transplantation lymphoproliferative disorder, graft rejection, and ABO- and HLA-incompatibility. The drug's potential utility in autoimmune conditions that affect the kidney, including focal segmental glomerulosclerosis and systemic lupus erythematosus, is also assessed.