Reviews & Analysis

A prematurely aged phenotype is a common characteristic of chronic kidney disease (CKD) and other chronic organ diseases, including heart failure and rheumatoid arthritis. In this opinion article, the authors suggest four major pathophysiological mechanisms that may underlie premature ageing in CKD.

Drug trial and approval processes are often affected by the conflicting interests of regulatory authorities, academia, and the pharmaceutical industry. In this Perspectives article, Silvio Garattini and Norberto Perico discuss examples of particular relevance to therapeutic interventions in nephrology, to highlight and summarize flaws in the current drug development process. The authors call on academia to develop more-effective relationships with both regulatory authorities and the pharmaceutical industry to balance public needs with commercial aims.

Recurrent dehydration and salt loss might be a mechanism that causes chronic kidney disease, whereby increased plasma osmolarity activates both intrarenal (polyol-fructokinase) and extrarenal (vasopressin) pathways to drive injury. The authors propose that water and salt influence blood pressure through the timing and combination of their intake, affecting plasma osmolarity and intrarenal and extrarenal mechanisms of renal injury.

Haemolytic uraemic syndrome (HUS) leads to anaemia, thrombocytopenia and, ultimately, acute renal failure. Some patients are also at risk of cardiovascular complications owing to mutations in the complement pathway, which result in microangiopathic injury of the coronary vasculature. This Perspectives article highlights the cardiovascular complications arising in patients with HUS and the implications for treatment of this rare disease.