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Estimating renal function in the normal to high range is challenging, and even more so in critically ill patients. An analysis of commonly used equations for estimating renal function demonstrates that these formulae might not be accurate in this setting, which has important implications for drug dosing.
Pre-emptive kidney transplantation (PKT) is considered the best treatment for advanced chronic renal failure. Transplantation done too early can cause premature transplantation risks; done too late, the recipient might be exposed to the complications of chronic kidney disease. Thus, a major question arises: when is the best time for PKT?
Recent clinical studies with bardoxolone methyl have demonstrated improvements in the glomerular filtration rate of diabetic patients with chronic kidney disease (CKD). Although its mechanism of action is uncertain, the persisting effects of bardoxolone methyl in this challenging group of patients are a source of optimism for the management of CKD.
The ASCERTAIN study has confirmed previous findings that conversion from calcineurin inhibitors to mammalian target of rapamycin (mTOR) inhibitors does not seem to improve glomerular filtration rate in renal transplant recipients, although it does seem beneficial in patients with better renal function at baseline. Questions remain regarding the role of mTOR inhibitors in kidney transplantation.
Patients with autosomal polycystic kidney disease develop cysts in a minority of their renal tubules, which can affect the function of a large number of nephrons. This Review analyzes the available facts on the development of renal failure in these patients to determine the respective effects of the cysts and the interstitial changes associated with them on the decline in glomerular filtration rate.
Calcification is highly prevalent and a leading cause of death in patients with chronic kidney disease. Noninvasive imaging techniques can be used to identify patients with calcification who are at high risk of clinical events, and monitor progression and treatment-related changes in calcification burden. The authors of this Review discuss noninvasive imaging techniques that are commonly used to assess vascular and valvular calcification and evaluate their advantages and limitations.
Most patients who are on dialysis require an oral phosphate binder; however, in the absence of robust data from clinical trials, guidelines on the ideal levels of phosphate in these patients are limited. This Review discusses the pharmacology, efficacy and safety of the available phosphate binders, and the problems associated with each binder.
Elderly patients with end-stage renal disease (ESRD) have a number of unique features that impact on the management of this condition. In this Review, Brown and Johansson highlight factors that need to be considered when treating elderly patients with ESRD. The authors also discuss the advantages and limitations of dialysis modalities in elderly patients with ESRD as well as the option of conservative care.
This article reports the case of a 73-year-old man who developed spondylodiscitis as a result of methicillin-sensitiveStaphylococcus aureusbacteremia. The patient's catheter was identified as the source of bacteremia, which had spread to the vertebral discs as confirmed by microbiological tests and MRI. The authors also discuss the characteristics of 12 other patients with spondylodiscitis and describe the risk factors for developing this condition and its most appropriate management.
