Articles in 2011

The podocyte is a key target of injury in a number of renal diseases. Although some current therapies—including glucocorticosteroids and calcineurin inhibitors—have potent effects on the podocyte, their effects are nonspecific and lead to unwanted systemic adverse effects. In this Review, Peter Mathieson describes how advances in our understanding of podocyte biology has enabled the identification of potential therapeutic targets that may be able to prevent or limit podocyte injury and/or promote podocyte repair or regeneration.

Several studies have indicated that an intensive continuous renal replacement therapy (CRRT) dose has no benefit over a standard CRRT dose. However, treatment-related factors may have influenced these findings. In this article, Macedo et al. discuss the assumption that delivered dialysis dose is equivalent to the effluent volume and highlight the importance of assessing filter efficacy and dose parameters in patients receiving CRRT.

Biomarkers have the potential to refine prognosis, improve risk stratification and guide therapy in patients on hemodialysis. The authors of this Review discuss the validation and potential use of biomarkers, including markers of chronic kidney disease-related mineral and bone disorders, markers of protein–energy wasting and inflammation, and markers of cardiovascular disease, in patients on hemodialysis. The authors also describe how proteomics can be used to identify and study new biomarkers.

Patients with acute kidney injury (AKI) complicating multiple myeloma often have poor outcomes. In this Review, Hutchison et al. discuss the pathogenic role of monoclonal free light chains in inducing proximal tubular damage and cast nephropathy in patients with multiple myeloma. The authors also provide an update on the diagnostic approaches to patients with AKI complicating multiple myeloma.

An understanding of the intricacies of cytoskeletal dynamics and regulation in podocytes is essential to facilitate investigation and treatment of patients with glomerular disease. This Review outlines the most recent concepts and advances in podocyte biology, and discusses how an improved understanding of the podocyte cytoskeleton is starting to shape advances in delineating the pathogenesis of common glomerular diseases.

Metabolomics—the nontargeted measurement of all metabolites produced by the body—holds promise for early diagnosis, increased choice of therapy and the identification of new metabolic pathways that could potentially be targeted in kidney disease. This Review discusses the techniques used in metabolomics and explores the limitations and future applications of this process.

A recent report from the Alberta Kidney Disease Network demonstrates that high estimated glomerular filtration rate is associated with an increased risk of all-cause mortality in both young and elderly individuals, as well as in those with and without proteinuria. Potential explanations and implications of these findings are discussed.

Whether erythropoiesis-stimulating agents (ESAs) administered in high doses could be harmful is a subject of intense interest. A recent trial has studied the relationship between hemoglobin level, ESA dose and outcomes in Japanese patients on hemodialysis. Here, we review the findings and the possible impact on clinical anemia treatment.

A new report suggests that differences in albuminuria might contribute to disparities in susceptibility to nephropathy in African American and white individuals. Interpretation of this finding requires consideration of renal histology, clinical trials and genetic studies. These factors indicate that a far more complex scenario is likely to exist than previously thought.

Renal fibrosis is the common final outcome of almost all chronic kidney diseases, and can predict prognosis and determine renal insufficiency. This process consists of four overlapping phases: priming, activation, execution and progression. In this Review, Youhua Liu outlines the cellular and molecular mechanisms of renal fibrosis, which could help the development of new therapeutic strategies.