News & Views

New data from a substudy of the SPRINT trial suggest a benefit of intensive blood pressure lowering in patients ≥75 years with hypertension. These new findings will be crucial to update guidelines on blood pressure control in the elderly hypertensive population, with targets potentially lower than those previously recommended.

Blood pressure lowering slows the progression of diabetic nephropathy whereas the effects of glycaemic control are smaller and slower. New findings from the EMA-REG OUTCOME investigators indicate that SGLT2 inhibition slows the progression of kidney disease by lowering glucose and blood pressure, thereby lowering the risk of adverse renal outcomes in this patient group.

A recent study suggests that salt reduction should be confined to hypertensive individuals with high salt intake. However, this study has serious methodological issues and its findings should therefore not challenge the strong evidence supporting the benefits of salt reduction for the general population.

A wearable haemodialysis device holds the promise of freedom for patients to carry on with their lives without the limitations associated with conventional dialysis. A new report of the outcomes of 24 h treatment with a wearable haemodialysis system represents a small but important step forward in the development of a wearable device.

Nephrotoxin-induced acute kidney injury (AKI) is a considerable risk among hospitalized children. The development and use of a proactive, nephrotoxin screening system seems to have led to a significant improvement in AKI rates in one children's hospital, suggesting that such systems might have broader implications for patient care.

Uncertainty exists regarding the optimal timing of initiation of renal replacement therapy in critically ill patients with acute kidney injury in the absence of urgent or life-threatening complications. Two high-profile trials — AKIKI and ELAIN — that aimed to address this issue have recently reported conflicting findings.

A new study reports an independent association between albuminuria and skin capillary rarefaction in a population-based cohort. These findings suggest that as well as reflecting injury to the glomeruli — a highly specialized microvascular bed — albuminuria might be a surrogate marker of systemic microvascular and endothelial dysfunction.

Antibodies against several podocyte antigens have evolved as markers of diagnosis, disease activity, and prognosis in membranous nephropathy, but their pathogenic role remains debated. Detailed work-up of two cases of primary and secondary membranous nephropathy now supports the concept that thrombospondin type-1 domain-containing 7A autoantibodies are pathogenic.

Time-averaged proteinuria (TAP) is thought to be the most reliable predictor of outcomes in IgA nephropathy (IgAN). New data suggest that corticosteroids reduce TAP and presumably improve outcomes in IgAN, but increase the risk of adverse effects. Whether TAP is a good surrogate end point for clinical trials remains unclear.

The 0by25 Global Snapshot sheds light on the recognition, management and outcomes of acute kidney injury (AKI) in countries worldwide stratified by gross national income. These novel epidemiological data open new horizons for preventing death from AKI particularly in developing countries.

The heterogeneity of pathomechanisms leading to systemic lupus erythematosus (SLE) might contribute to between-patient variations in treatment response. A new, longitudinal transcriptome analysis has identified molecularly distinct subgroups of SLE that correlate with disease activity; use of such disease classifiers might facilitate the development of stratified treatment recommendations.

Polycystic Kidney disease (PKD) is caused by mutations in genes that affect cilia structure and composition. Impaired mechanosensation through primary cilia has been proposed as a pathogenic mechanism in PKD; however, a new study challenges this hypothesis by showing an absence of mechanically induced Ca²⁺ increases in primary cilia.

The first, highly anticipated randomized trial of adjuvant antiangiogenic therapy in renal cancer was recently reported. Although far from assuring, data from the adjuvant sorafenib or sunitinib for unfavorable renal carcinoma (ASSURE) trial offer a wealth of insights into the disease, treatments, and biological considerations for studies aimed at risk reduction.

A single-centre study found that desensitization therapy permits a good success rate of kidney transplantation with an incompatible living donor. Data from 22 US centres now suggest that this technique could be employed across multiple hospitals to prolong the lives of sensitized transplant recipients.

New data demonstrate that caplacizumab treatment accelerates normalization of platelet count in patients with acute episodes of acquired thrombotic thrombocytopenic purpura (TTP). Although not curative, this drug might reduce ischaemic organ damage and be potentially lifesaving for patients with TTP who do not respond to conventional therapy.

New data from the BENEFIT study demonstrate that belatacept improves long-term allograft and patient survival after kidney transplantation, despite higher rates of biopsy-proven acute rejection than with ciclosporin. The noninferiority design of BENEFIT represents a feasible strategy to further the development of innovator drugs to reduce late graft loss.

Clinical trials in patients with acute kidney injury (AKI) have been stymied by a lack of consensus on suitable renal-specific end points. In a recent analysis, Grams et al. suggest that a sustained 30–40% reduction in estimated glomerular filtration rate after hospital discharge might be a suitable intermediate end point for AKI clinical trials.

New data suggest that a fall in parathyroid hormone (PTH) 12 months after initiating haemodialysis is associated with cardiovascular death at 12–24 months. The main independent predictor for the fall in PTH is a high dialysate calcium concentration, which might not only reduce PTH but also induce vascular calcification.

A new study reports that a single blood test can be used to rule out the development of pre-eclampsia in women in whom the syndrome is suspected. Early interventions for pre-eclampsia are not yet available, but this finding is likely to change the approach to diagnosis of hypertensive disorders in pregnancy.

A recent meta-analysis reports that blood-pressure-lowering treatments reduce the rate of cardiovascular events in patients with baseline systolic blood pressures ranging from >160 mmHg to <130 mmHg. Notwithstanding their diverse data sources, the researchers assert that a blood pressure target of <130 mmHg should be adopted when treating hypertension.