Volume 12 Issue 5, May 2016

New data demonstrate that caplacizumab treatment accelerates normalization of platelet count in patients with acute episodes of acquired thrombotic thrombocytopenic purpura (TTP). Although not curative, this drug might reduce ischaemic organ damage and be potentially lifesaving for patients with TTP who do not respond to conventional therapy.

New data from the BENEFIT study demonstrate that belatacept improves long-term allograft and patient survival after kidney transplantation, despite higher rates of biopsy-proven acute rejection than with ciclosporin. The noninferiority design of BENEFIT represents a feasible strategy to further the development of innovator drugs to reduce late graft loss.

Clinical trials in patients with acute kidney injury (AKI) have been stymied by a lack of consensus on suitable renal-specific end points. In a recent analysis, Grams et al. suggest that a sustained 30–40% reduction in estimated glomerular filtration rate after hospital discharge might be a suitable intermediate end point for AKI clinical trials.

New data suggest that a fall in parathyroid hormone (PTH) 12 months after initiating haemodialysis is associated with cardiovascular death at 12–24 months. The main independent predictor for the fall in PTH is a high dialysate calcium concentration, which might not only reduce PTH but also induce vascular calcification.

Healthy mitochondria are essential for normal kidney function and mitochondrial dysfunction has been implicated in various types of renal disorders, both inherited and acquired. In this article, the authors review mitochondrial cytopathies with renal manifestations and the role of mitochondrial dysfunction in acute kidney injury (AKI).

Graft necrosis resulting from ischaemia–reperfusion injury leads to the release of endogenous molecules — damage-associated molecular patterns (DAMPs) — which trigger a sterile inflammatory reaction. The resulting immune response can impair transplant tolerance or result in acute or chronic graft rejection. In this Review, Braza et al. discuss the nature of DAMPs and their downstream signalling pathways, with a focus on Toll-like receptors. They outline various strategies to inhibit DAMP-induced inflammation with the aim of improving the outcomes of solid organ transplantation, and discuss the challenge of inhibiting the innate immune response within the graft without compromising the patient's response to pathogens.

Renal disease is a frequent complication of HIV infection, and a spectrum of renal disorders has been described with diverse histopathologic forms. In this Review, Scott Cohen and colleagues outline the epidemiology of renal disease in HIV and how it has changed since the introduction of combined antiretroviral therapy. They discuss the clinical manifestations and mechanisms underlying renal disease development in patients with HIV, and the issues pertaining to diagnosis and therapeutics.

Renal transplantation can be successfully performed in patients of all ages, and the short-term and medium-term outcomes have improved over the past decades. In this Review, Christer Holmberg and Hannu Jalanko discuss the long-term effects of kidney transplantation on paediatric recipients. They outline the adverse effects that can occur with regard to growth, bone health, metabolic and cardiovascular complications, and malignancies, and highlight the challenges that remain in managing the care of paediatric renal transplant recipients.