Review Articles in 2013

Community-acquired acute kidney injury (AKI) has a varied aetiology and is prevalent in developing tropical countries. In this Review, the authors discuss the main causes of community-acquired AKI in tropical countries and the effect of climate and socioeconomic factors on disease prevalence. The authors also discuss future strategies to reduce the burden of AKI in the tropics.

Experimental, epidemiological and clinical studies have demonstrated that vasopressin contributes to the progression of chronic kidney disease by imposing an increased burden on diseased nephrons, and to autosomal dominant polycystic kidney disease by promoting cyst growth. Vasopressin also has a role in the pathogenesis of diabetes mellitus and metabolic disorders. This Review describes the adverse effects of vasopressin and provides insights into vasopressin physiology that may be relevant to the understanding of these adverse effects.

Anaemia is common in patients with chronic kidney disease (CKD) and is associated with increased mortality and morbidity. This Review describes findings from randomized controlled trials and observational studies investigating how target haemoglobin level and erythropoiesis-stimulating agent (ESA) dose affect outcomes in patients with CKD and discusses whether high haemoglobin targets, high ESA dosage or ESA resistance are risk factors for adverse outcomes.

Many noninsulin glucose-lowering agents have pharmokinetic and elimination profiles that preclude their use in patients with reduced renal function. However, several of these drugs can be used safely in patients on dialysis and should be considered by physicians. In this Review, the authors provide a guide to the use of noninsulin hypoglycaemic agents for the management of diabetes in patients receiving dialysis and also discuss the monitoring of glycaemic control in these patients.

Podocytes, a key component of the glomerular filtration barrier, adhere tightly to the glomerular basement membrane (GBM) through the actions of extracellular ligands within the GBM, transmembrane podocyte adhesion receptors, and intracellular linker proteins. This Review summarizes recent advances in our understanding of the cell biology and genetics of podocyte adhesion with a focus on its functional relevance in physiology and disease.

Rituximab offers an alternative approach to current immunosuppressive therapies for patients with difficult-to-treat, steroid-dependent nephrotic syndrome. Rituximab therapy has been shown to induce and maintain remission in these patients; however, most data are derived from anecdotal reports or case series. This Review provides an overview of available data on the safety and efficacy of rituximab in the treatment of paediatric and adult patients with nephrotic syndrome.

Cellular regeneration—the repair of portions of the existing nephron after tubular damage—is conserved in all animal species. By contrast, nephron neogenesis is present in lower branches of the animal kingdom, but not in adult mammals. Converging evidence suggests that a renal progenitor system is present in the adult kidney across different stages of evolution. Here, the authors look at renal regeneration from an evolutionary perspective and suggest possible explanations for the differences between animals.

This Review discusses the concept of Ras-related C3 botulinum toxin substrate 1 (Rac1)-induced activation of the mineralocorticoid receptor and highlights the available evidence for the roles of Rac1 and mineralocorticoid-receptor activation in cardiac and renal disease. The authors suggest that agents that regulate the activity of the Rac1-mineralocorticoid-receptor pathway could be novel therapeutic candidates for the treatment of chronic kidney disease and cardiac injury.