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Several surprising findings indicate that pharmacological blocking of the multifunctional enzyme mTOR fosters distinct differentiation programs in different immunocompetent cells. These data might lead to a striking change in our view of the role that mTOR inhibition should have in immunosuppressive therapy for allogeneic transplant recipients.
In vitro evidence suggests that immune complex formation in IgA nephropathy is determined by the sugar content of the IgA1 hinge region. Absence of galactose residues in this region renders the IgA1 molecule immunogenic.
Vitamin D insufficiency is endemic amongst renal transplant recipients, as it is in other individuals with chronic diseases, both within and beyond nephrology. Few data exist to guide vitamin D replacement strategies, but indirect evidence points to likely skeletal, and possibly extraskeletal, benefits from supplementation.
In patients on hemodialysis with a history of failure to respond to hepatitis B vaccination, intradermal revaccination is more effective than repeat intramuscular vaccination. Intradermal vaccine administration might become the standard of care for high-risk patients.
Proof has at last been provided that idiopathic membranous nephropathy is caused by autoantibodies to proteins expressed by podocytes. The discovery that autoantibodies to the M-type secretory phospholipase A2 receptor were present in most individuals affected by the condition opens a new era for the management of membranous nephropathy.
Induction therapy with rabbit anti-thymocyte globulin is preferable to induction with daclizumab in renal transplant recipients at high immunological risk. These findings provide additional support to the idea that personalized immunosuppressive regimens should be developed in renal transplant recipients.
Abnormalities of immunoglobulin free light chains (FLCs) are frequently present in patients with monoclonal gammopathies and can cause kidney disease. The recent introduction of highly sensitive immunoassays that measure FLCs to levels below those present in normal individuals has provided a new tool for diagnosis and management in this setting. In this article, Hutchison and colleagues review the biology of FLC production in health and disease, and the utility of FLC immunoassays in the assessment of monoclonal gammopathies in kidney disease.
The incidence and mortality of sepsis and the associated development of acute kidney injury (AKI) remain high, despite intense research into potential treatment strategies. Inducible nitric oxide synthase—which is constitutively expressed in the kidney but is not expressed in many other organs—has known importance in the pathogenesis of sepsis-induced AKI in humans. In this article, Heemskerk and colleagues discuss the selective inhibition of iNOS as a potential novel treatment for sepsis-induced AKI.
The heart and kidney can mutually influence each other's function so that dysfunction in one organ can result in dysfunction in the other. In this Review, Khaled Shamseddin and Patrick Parfrey describe the mechanisms involved in this two-way interaction, with reference to the classification of the so-called cardiorenal syndromes introduced in 2008 by Claudio Ronco and colleagues.
Kidney Disease: Improving Global Outcomes (KDIGO) is an independent organization that aims to improve care and outcomes for patients with kidney disease worldwide through the development and dissemination of clinical practice guidelines. In this Review, the current co-chairs of KDIGO discuss the structure, methodology and activities of KDIGO and describe how KDIGO is trying to meet the multiple challenges of guideline development.
In this Case Study, Hladunewich and colleagues describe the case of a woman with a twin pregnancy with a single fetal demise who presented earlier than 20 weeks' gestation with severe nephrotic syndrome, hypertension and renal insufficiency. The authors describe how aberrant levels of anti-angiogenic and angiogenic factors helped confirm the diagnosis of pre-eclampsia in this complex renal presentation, allowing for the rapid discontinuation of unnecessary immunosuppressive agents and the avoidance of the potential risks inherent with diagnostic renal biopsy.
