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A group chaired by a rheumatologist recently published a consensus document inArthritis and Rheumatismthat codified definitions of renal responses and non-responses to therapy in patients with lupus nephritis. In this Viewpoint, the co-director of a renal-rheumatology lupus clinic argues that nephrologists have a key role to play in the diagnosis and treatment of lupus nephritis, and that they should not allow rheumatologists to take over the management of this condition.
Unfortunately, dialysis and kidney transplantation do not always ameliorate the retarded growth that is a feature of pediatric end-stage renal disease. This discussion encompasses the main factors that affect the growth of children after transplantation, including age at transplantation, function of the grafted kidney and use of corticosteroids. Evidence for and against the use of recombinant human growth hormone in this patient population is presented.
The authors present the latest evidence supporting genetic contributions to IgA nephropathy, a common form of primary glomerulonephritis throughout the world. No specific causative gene has yet been detected, but defective glycosylation of IgA1 leading to formation of immune complexes has been consistently implicated. The prevalence of familial forms of the condition varies depending on geography and ethnicity. The clinical patterns of these under-recognized familial forms are reviewed here.
A group from Technion, Israel, presents data to support an association between diabetic complications and the pattern of inheritance of alleles for the hemoglobin-binding protein haptoglobin. Experimental and preliminary clinical evidence indicate that the antioxidant protection conferred by haptoglobin is dependent upon genotype. Confirmation of the hypothesis will provide the rationale for trials of genotype-guided antioxidant therapies in diabetic populations.
