Articles in 2018

Renal cell carcinoma (RCC) is the most common malignancy seen in the nephrology clinic, yet most nephrologists have inadequate knowledge of current treatment options. Here we discuss RCC presentation and therapies, including potential renal adverse effects, and highlight the need for involvement of nephrologists in the multidisciplinary management of this disease.

The authors present sexual dimorphism at the molecular, cellular and tissue level and suggest that it contributes to differences in disease onset, susceptibility, prevalence and treatment responses in hypertension and cardiovascular disease. Several factors that confer relative cardioprotection in women are discussed, including biological age, sex hormones, sex chromosome complement and lifestyle.

Increasing evidence suggests that renin-expressing cells are involved in a range of physiological processes beyond their traditional role in blood pressure regulation. Here, the authors describe the role of these cells in nephrovascular development, regeneration, oxygen sensing, haematopoiesis and immune responses.

Here, four leading researchers discuss key considerations related to women's kidney health, including specific risk factors, the main challenges and barriers to care and policies and systems that could be implemented to improve the kidney health of women and their offspring.

Focal segmental glomerulosclerosis (FSGS) is a common and progressive form of kidney injury for which treatment options are limited. New findings from a study in animal models of FSGS suggest that a small molecule inhibitor of the TRPC5 ion channel could provide therapeutic benefit.

New data from the PRESERVE trial suggest that administration of N-acetylcysteine and/or sodium bicarbonate does not reduce the incidence of acute kidney injury in patients with chronic kidney disease undergoing angiography. Given the limitations of this study, use of these antioxidants should be considered discretionary until further data becomes available.

A growing body of research indicates that sex and gender-specific differences exist in the mechanisms and epidemiology of chronic kidney disease (CKD). Here, the authors describe current understanding of gender and sex differences in the epidemiology, treatment and outcomes of CKD, as well as the possible underlying causes.

Chronic kidney disease (CKD) is associated with an increased risk of adverse pregnancy outcomes. Here, Wiles et al. discuss fertility issues, contraception, important comorbidities, drugs commonly used in nephrology and the effect of dialysis provision in the context of CKD. Advances in biomarkers for CKD and pre-eclampsia are also presented.

Acute kidney injury is a heterogeneous clinical syndrome with multiple aetiologies, including sepsis, surgery, hypoperfusion and nephrotoxin exposure. Here, Kellum and Prowle discuss the different causes, phenotypes and pathogenic pathways of AKI and describe how consideration of such paradigms could be used to guide treatment.

Some animals have developed mechanisms to protect them from environmental stresses, whereas others remain susceptible. Here, Stenvinkel et al. discuss how a better understanding of susceptibility and protective mechanisms could provide insights to novel strategies for the prevention and treatment of several human diseases, such as chronic kidney disease and ageing-associated complications.

Technical advances in genome sequencing and association studies have yielded critical insights into the genetic architecture of kidney diseases. Here, I summarize four key studies from 2017 that deciphered the genetic basis of known and novel diseases and provided insights into the mechanisms of glomerular, developmental defects and manifestations of kidney disorders.

2017 saw the emergence of a new era in renoprotective medicine for diabetic kidney disease with reports of promising renal outcomes with the sodium–glucose cotransporter 2 (SGLT2) inhibitors empagliflozin and canagliflozin from follow-up analyses of the EMPA-REG OUTCOME trial and the CANVAS Program, respectively, and with use of the glucagon-like peptide 1 (GLP1) agonist liraglutide in the LEADER trial.

Genomic medicine approaches are increasingly used for diagnosis of kidney disease. Here, the authors discuss sequencing modalities, the interpretation and clinical application of genetic data, and the challenges that must be overcome to realize the potential of genomic medicine in nephrology.