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The underlying cause of hypertension is unknown in the vast majority of patients with high blood pressure. This Perspectives article discusses the role of T cells in renal inflammation and how autoimmunity, mediated by heat shock proteins, leads to salt-sensitive hypertension.
As the prevalence of chronic kidney disease increases, new strategies to reverse or prevent tissue damage are under investigation. Here, Rabelink and Little describe progenitor cell populations that may have a key role in tissue repair and regeneration in the kidney. They also discuss the potential to harness the innate regenerative capacity of the kidney in the context of ongoing studies of mesenchymal stromal cell therapy.
Acute kidney injury (AKI) is a growing problem in hospitalized patients and is associated with adverse outcomes. Recognizing renal injury earlier—at the stage of 'incipient AKI'—may enable renoprotective strategies to be initiated at a time when more kidney tissue is salvageable. In this article, the authors propose three strategies that may preserve kidney function and minimize further kidney injury in patients with 'incipient AKI'.
A strong inter-relationship seems to exist between the peritoneal membrane and the kidney in patients on peritoneal dialysis. In this Perspectives article, Nessim and Bargman describe examples of this interplay—such as the mechanisms by which alterations in peritoneal membrane function may influence residual renal function and vice versa—and propose that this interplay be characterized by a new term: 'peritoneal–renal syndrome'.
Variants in two neighbouring genes,APOL1 and MYH9, have previously been associated with kidney disease. Here, using 1000 genomes data, the authors reason by exclusion that the APOL1variants are in fact the most likely causal variants involved in kidney disease, and that this genomic region should be targeted in future studies to determine function.
Advances in molecular genetics and genomic science are improving our understanding of the molecular basis of nephrotic syndrome. However, the availability of genetic testing in the management of nephrotic syndrome poses unique challenges for clinicians in terms of who to test and how best to use the information obtained. Here, the authors present their collective opinion on the clinical indications for and the utility of genetic testing in monogenic nephrotic syndrome based on the evidence available to date.
