Articles in 2016

Blood pressure (BP) goals and the management of BP in patients with chronic kidney disease (CKD) remain controversial topics. Key articles in the past year have addressed BP goals in CKD, the use of new agents to slow CKD progression and the effects of visit-to-visit variability in systolic BP on cardiovascular events and renal progression in patients with CKD.

As IgA nephropathy (IgAN) is considered to result in part from autoimmune processes, B-cell depletion using rituximab might be a plausible therapy. However, a small randomized, controlled trial in patients at risk of progressive IgAN reports that this therapy failed to reduce proteinuria over 1 year and was associated with more adverse events per patient.

In many countries, patient outcomes with peritoneal dialysis are comparable or superior to those with haemodialysis. Here, the authors discuss the changing epidemiology of peritoneal dialysis worldwide, including the remaining country-specific challenges that must be overcome to improve utilization of this cost-effective therapy.

Senescent cells, which accumulate with ageing, are also involved in organ development and disease. Here, the authors examine the beneficial and detrimental effects of chronic and acute senescent cells in kidney formation, repair, disease and ageing and how these can be therapeutically modulated.

One of the first manifestations of cystinosis is a renal Fanconi syndrome, characterized by severe dysfunction of proximal tubule cells. This Review describes the pathogenesis of renal Fanconi syndrome in cystinosis, focusing on the importance of cystinosin in the maintenance of cellular homeostasis beyond its function in cystine transport.

Estimates of the prevalence of chronic kidney disease (CKD) vary widely, both within and between countries. Here, the authors discuss the origins of this variation, particularly issues relating to the use of estimated glomerular filtration rate, and present solutions for tackling the factors responsible.

The kidney has a key role in maintaining glucose homeostasis and is the site of action of SGLT2 inhibitors, which enhance glucose excretion to reduce plasma glucose levels. Here, Ralph DeFronzo and colleagues examine the role of the kidney in regulating glucose reabsorption and the effect of SGLT2 inhibition on renal function, glucose homeostasis, and cardiovascular disease.

New data suggest that provision of high-protein, high-calorie intradialytic meals in combination with phosphate binder therapy could be an easy and effective strategy to reduce the risk of malnutrition in patients on haemodialysis. These findings highlight the importance of avoiding excessive dietary restrictions in these patients.

Cellular plasticity facilitates organ repair after injury. Here, the authors discuss the modalities and mechanisms of cellular plasticity such as dedifferentiation and progenitor expansion in the kidney and their contribution to renal repair.

New data suggests that, in addition to mutations in tumour-suppressor genes, renal cancer is associated with epigenetic aberrations. Here, the authors discuss the mechanisms by which epigenetically silenced genes and mutations in genes that are involved in histone modification or chromatin remodelling dysregulate crucial cellular pathways in renal cancer.

In a recent trial, levosimendan therapy failed to ameliorate sepsis-induced organ dysfunction or improve the survival of patients with septic shock. The failure of levosimendan and many other potential therapies for sepsis, together with the findings of histopathologic studies, raise questions regarding the pathophysiologic basis of the disorder.