Volume 11 Issue 12, December 2015

A new study reports that addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to renin–angiotensin system (RAS) blockade resulted in a reduction in albuminuria in patients with diabetic nephropathy. Such a strategy might provide an opportunity to maximize the beneficial effects of RAS blockade without increasing the risk of hyperkalaemia.

A new study reports that B7-1 is not expressed on the podocytes of patients or mice with diabetic nephropathy. In contrast to the findings of some previous studies, these data suggest that targeting B7-1 on podocytes using abatacept might not be an appropriate therapeutic strategy for diabetic renal disease.

Cell therapy holds promise to enable efficient repair of the adult human kidney, which could reverse damage caused by repeated renal injury. In this Review, Bussolati and Camussi consider the latest evidence for the existence and origin of functional renal progenitor cells in adult humans and the role of these cells in renal repair. They then discuss strategies for generating renal progenitor cells from pluripotent stem cells, human fetal cells and adult renal cells that could be used for cell therapy.

The kidney and the brain exhibit extensive organ crosstalk due to similarities in their vasculature and shared humoral and non-humoral pathways. In this Review, Claudio Ronco et al. evaluate the effects of chronic kidney disease, end-stage renal disease, and acute kidney injury on cognitive and cerebrovascular function. The authors also highlight the risk factors for cognitive impairment in patients undergoing dialysis.

Congenital anomalies of the kidney and urinary tract (CAKUT) are a spectrum of renal disorders that commonly cause end-stage renal disease in children, but their genetic basis is largely unknown. In this Review, Nine Knoers et al. discuss the difficulties in identifying the genetic basis of CAKUT, the approaches used to detect genetic variants that confer risk of these anomalies, and the complex interplay between environmental factors, epigenetics, and genetic variants in contributing to the development of these syndromes.

The development of effective desensitization strategies has enabled ABO incompatible (ABOi) kidney transplantation to become an established treatment option for patients with end-stage renal disease. Here, the authors review the mechanisms that underlie acceptance and rejection of ABOi grafts, recipient desensitization strategies, patient outcomes and novel treatment strategies that might promote graft acceptance and enable minimization of immunosuppression.