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Since the publication of the CHOIR and CREATE study results, tremendous attention has focused on the cardiovascular effects of anemia correction in patients with chronic kidney disease. Less publicized has been the finding of a potentially higher risk of progression to end-stage renal disease among patients assigned to a higher hemoglobin target. Ajay K Singh examines whether the sum of evidence indicates a harmful or a beneficial effect of anemia correction on the progression of kidney disease.
Until recently gadolinium chelates were thought to be safe when used as contrast agents for MRI. These compounds are now known to be associated with artifactual results of laboratory tests, acute kidney injury and nephrogenic systemic fibrosis, complications that seem to exclusively affect people with impaired renal function. Penfield and Reilly provide the information that physicians need to determine the relative risks and benefits of administering gadolinium to patients with chronic kidney disease.
There are several renal syndromes that are unique to patients with cancer, being caused either by the cancer itself or by its treatment. This Review provides nephrologists—who are essential members of the multidisciplinary team that cares for patients with malignancy—with an overview of these syndromes. The article is divided into sections that deal with the renal impact of different cancer types, interventions, and commonly used chemotherapeutic and biological agents.
The difficulties that are inherent in the differential diagnosis of hemolytic uremic syndrome and thrombotic thrombocytopenic purpura are a function of the overlap in presenting features. The authors of this Review assert that patient management could be more usefully directed by basing diagnosis on recently elucidated pathogenic mechanisms. To that end, they discuss the involvement of deficiencies in metalloprotease ADAMTS13, and dysfunctional complement proteins.
Tuberculosis is a serious opportunistic infection in renal transplant recipients. Post-transplantation tuberculosis most commonly occurs within the first few years of receipt of a renal allograft, but Ram et al. present the case of a 27-year-old male who presented with isolated skin ulcers caused by Mycobacterium tuberculosis 12 years after kidney transplantation. They review the literature on post-transplantation tuberculosis and discuss treatment options.
