Volume 9 Issue 9, September 2013

Effective treatments for atypical haemolytic uraemic syndrome (aHUS) have long been lacking, but the discovery that complement dysregulation is a major risk factor for this disease and the availability of the complement inhibitor eculizumab have improved the clinical picture. Legendre et al. have now published results from two prospective trials investigating eculizumab use in aHUS. Although we have come a long way, questions remain.

Whether use of non-calcium-containing phosphate binders versus calcium-containing phosphate binders improves outcomes for patients with chronic kidney disease is unclear. Now, new data from an open-label randomized controlled trial suggest that the non-calcium-containing phosphate binder sevelamer hydrochloride significantly improves survival compared to calcium carbonate in incident patients on haemodialysis.

Caroli et al. recently used a haemodynamic computational model to simulate changes in vessel dimensions and blood flow volumes in response to arteriovenous fistula (AVF) creation. This study has provided new insights into the use of preoperative ultrasound to identify sites for AVF creation and reduce rates of fistula nonmaturation.

The integration of omics analyses of primary glomerular diseases with data from clinical and histopathological studies is expected to advance our understanding of the molecular basis of these diseases and lead to improvements in diagnosis and treatment. Here, the authors provide an up-to-date overview of omics studies of primary glomerular diseases and suggest new approaches to further characterize their pathogenetic mechanisms, candidate genes, potential biomarkers and therapeutic targets.

Various equations have been developed for estimating glomerular filtration rate (GFR), but the issues surrounding GFR estimation are heavily debated. Although many guidelines now recommend the newer MDRD and CKD-EPI equations over the Cockcroft–Gault equation, these equations do fail to provide accurate estimates of GFR in some situations. This article discusses the development of the different equations and describes clinical situations in which the applicability of the equations is questioned.

In this Review, Zhi-Hong Liu describes the current status of nephrology in China, with particular reference to chronic kidney disease, acute kidney injury and kidney transplantation. She also discusses the potential of Chinese health-care reforms to increase the prevalence of dialysis and improve long-term outcomes for patients with chronic kidney disease.

Sporadic and hereditary forms of renal cell carcinoma, von Hippel–Lindau (VHL) disease and the familial paraganglioma syndromes are closely related in terms of their clinical and molecular genetic aspects. In this Review, the authors discuss pathogenesis, treatment and preventive strategies for VHL disease, VHL-disease-specific renal lesions, and familial paraganglioma syndromes.

Obesity-related metabolic syndrome is a growing health concern. The heart and kidneys are physiologically interdependent, and the pathological effects of obesity can lead to cardiorenal syndrome and, ultimately, kidney and heart failure. In this Review, the authors describe the complex interactions by which obesity might affect physiological cardiorenal interactions. They also discuss the potential roles of surgically induced weight loss and enhanced metabolic activity in the treatment of obesity-related cardiorenal syndrome.