Review Articles in 2010

Proliferative lupus nephritis is the most severe form of lupus nephritis. Outcomes of patients with proliferative lupus nephritis improved dramatically following the introduction of corticosteroids and cyclophosphamide, but many patients still develop end-stage renal disease. In this Review, Tesar and Hruskova discuss the clinical course of lupus nephritis, factors that predict outcomes, current induction and maintenance treatments, and recent advances in treatment options.

Paraneoplastic glomerulonephritis is a rare complication of malignancy that is frequently mistaken for idiopathic glomerulonephritis. Failure to recognize paraneoplastic glomerulonephritis can subject patients to ineffective and potentially harmful therapy. This Review describes potential pathogenetic mechanisms of paraneoplastic glomerulonephritides associated with different malignancies and aims to provide a reference for the diagnosis and treatment of paraneoplastic glomerulonephritides for the practicing clinician.

An appreciation of the health benefits conferred by polyunsaturated fatty acid (PUFA) consumption is growing, particularly in the field of cardiovascular disease, the leading cause of death in diabetes mellitus and diabetic nephropathy. In this article, Shapiro and colleagues provide a brief overview of the role of PUFAs in nutrition and metabolism, discuss the evidence which suggests that certain PUFAs reduce the risk of cardiovascular disease, and describe results from studies investigating the effect of specific PUFAs on diabetic nephropathy.

Postrenal transplant hemolytic uremic syndrome (HUS) can occur as a recurrent orde novodisease. Improved understanding of the mechanisms by which atypical HUS occurs after transplantation should result in the improved management of affected patients. In this Review, Zuber and colleagues discuss recent advances in our understanding of the pathogenesis of atypical HUS and describe diagnostic and therapeutic considerations with regard to renal transplantation in these patients.

Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease and atherosclerosis. In this Review, Kon and colleagues discuss CKD-induced atherosclerosis, with a particular focus on the experimental and clinical findings that support a key role for macrophages in atherogenesis. The authors describe how CKD can affect macrophage accumulation and function, including the roles of lipid, lipoprotein handling and angiotensin II in these processes.

Hypertension is a chronic disease that can lead to the development of chronic kidney disease (CKD) or exist as a comorbidity of CKD, and can contribute to disease progression. In this Review, Udani and colleagues discuss the pathogenesis, prevalence and epidemiology of hypertension associated with CKD. Major factors in the diagnosis and treatment of CKD-associated hypertension are also described.

Diabetic nephropathy and retinopathy are serious complications of diabetes, but the mechanisms involved in the progression of these entities are unknown. In this Review, Nakagawa and colleagues discuss clinical and experimental evidence, especially data from mouse models of diabetes, supporting endothelial nitric oxide deficiency and endothelial dysfunction as key factors in the development of diabetic nephropathy and retinopathy. The effectiveness of agents that target the renin–angiotensin system as treatments for diabetic nephropathy is also discussed.

Cytomegalovirus (CMV) infections are among the most common infections that can occur following solid organ transplantation. Although overall awareness of CMV disease has improved, several challenges remain with regards to its management. In this Review, Camille Kotton provides an overview of CMV diagnostics, methods for the prevention of CMV infection, and progress in the management of this disease.

The prevalence of cardiovascular disease is high in patients with chronic kidney disease (CKD), especially in those with end-stage renal disease. In this Review, Drüeke and Massy discuss the contribution of atherosclerosis to the development of cardiovascular disease in patients with CKD and describe data from clinical, imaging, morphological and experimental studies that provide evidence for atherogenesis as CKD progresses.

Iron deficiency is common in patients with chronic kidney disease (CKD) and administration of iron supplements could help maintain target levels of hemoglobin and reduce, or remove, the need for erythropoiesis-stimulating agents. In this Review, Besarab & Coyne discuss the efficacy, safety and practical recommendations for oral and intravenous therapy in the treatment of anemia in patients with CKD.

Hereditary disorders of renal phosphate wasting are rare genetic diseases. Affected patients can be symptomatic during childhood or adulthood, depending on the disease entity. In this Review, Alizadeh Naderi and Reilly provide an overview of a number of renal phosphate wasting disorders, focusing on their mode of inheritance, the effect of the responsible mutation, and clinical symptoms.

Contrast-induced acute kidney injury (CIAKI) is a leading cause of iatrogenic renal failure. Multiple studies have shown that patients with diabetic nephropathy who are exposed to contrast media are at high risk of CIAKI. This Review describes the pathogenesis of CIAKI in patients with diabetic nephropathy and discusses both currently available strategies and potential future strategies for CIAKI prevention.

Although living donor kidney transplantation is often presented as the best option for patients awaiting renal transplantation, patients whose renal failure is the result of an inherited disease might not be suitable candidates for transplantation from a living related donor. In this Review, Patrick Niaudet discusses hereditary nephropathies for which living donor kidney transplantation is a viable option as well as diseases for which living donor transplantation is contraindicated.

Tubulointerstitial hypoxia is increasingly recognized to have a key role in the progression of chronic kidney disease to end-stage renal disease. In this Review, Mimura and Nangaku discuss the different factors that contribute to the development of hypoxia in the tubulointerstitium and the susceptibility of different kidney cell types to hypoxia. Methods to detect hypoxia and potential therapeutic approaches to target chronic hypoxia in the kidney are also described.

Renal fibrosis is the common end point of virtually all progressive kidney diseases and a detailed understanding of the underlying mechanisms is required for the development of effective therapeutic strategies. In this Review, Boor and colleagues discuss the most recent advances in renal, or more specifically, tubulointerstitial fibrosis. Consideration is given to novel mechanisms as well as potential treatment targets based on different cell types.

Many immunosuppressive agents used in renal transplantation are associated with an increased risk of cancer, and malignancy is the third most common cause of death among renal transplant recipients at all time points after transplantation. In this Review, Rama and Grinyó describe the epidemiological and clinical characteristics of common tumor types that occur in renal transplant recipients. They also discuss the potential pathogenic mechanisms involved in tumor development in these patients, with a particular focus on the involvement of immunosuppressive treatments.

The success of organ transplantation is limited by the host immune response to the foreign graft and the adverse effects of chronic immunosuppressive therapy. The induction of mixed chimerism through the transplantation of donor hematopoietic stem cells is an effective approach towards achieving tolerance to donor tissue and holds great promise in improving transplant survival. This Review describes recent insights into the induction of transplantation tolerance through mixed chimerism and discusses the potential and challenges of this approach.

B cells have important roles in both graft rejection and in transplantation tolerance. In this Review, Kirk and colleagues discuss the mechanisms involved in the induction of B-cell tolerance and describe current and emerging therapies for treating antibody-mediated graft rejection.

The past few decades have seen great advances in genetics and molecular cell biology. Advances in chemistry and engineering have enabled increased data throughput, permitting the study of complete sets of molecules with increasing speed and accuracy using techniques such as genomics, transcriptomics, proteomics, and metabolomics. In this Review, the authors discuss the opportunities that molecular diagnostic tools have to offer both basic scientists and translational researchers in the field of transplantation.

The immune system has evolved to ensure protection against ever changing microbial pathogens. The potential of lymphocytes to recognize 'self' is controlled by a process called 'self tolerance'. Improved understanding of the mechanisms of immunological tolerance is key to understanding the pathogenesis of autoimmune disorders and cancers, and may lead to strategies to harness tolerance to replace the lifelong need for immunosuppressive drugs after organ transplantation. In this Review, Waldmann provides an overview of the mechanisms of self tolerance and assesses the prospects of translating this knowledge to patient care.