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Determining the optimal method for preserving deceased-donor kidneys is crucial for improving long-term transplant success. A randomized, controlled trial has compared two methods—hypothermic machine perfusion and cold storage preservation.
Mortality rates of patients with low levels of serum albumin, a marker of malnutrition and inflammation, are lower when hemodialysis is performed with high-flux membranes than with low-flux membranes.
ONTARGET showed that dual renin–angiotensin system blockade prevents microalbuminuria but facilitates transient renal function impairment in nonproteinuric patients with atherosclerotic vascular disease or diabetes. These findings should not be used as an excuse not to optimize renin–angiotensin system inhibition and target urinary protein in patients with proteinuric nephropathies.
In patients with hypertension in hemodialysis, dry-weight reduction by additional ultrafiltration leads to decreases in systolic and diastolic blood pressure. Ultrafiltration combined with daily dietary salt restriction should, therefore, be recommended to these patients, even in the absence of clinical signs of volume overload.
The transient receptor potential (TRP) is a protein superfamily whose members include 28 proteins known to be expressed in humans. Several TRPs are also expressed along the human nephron, and Titia Woudenberg-Vrenken and her colleagues discuss the evidence on the function of these renal TRPs and the possible relationship between channel or channel-regulation dysfunction and disease.
The presence of renal dysfunction in a patient receiving chemotherapy can be devastating. Many patients with cancer have underlying compromised renal function, and some chemotherapeutic agents actually induce renal abnormalities. In this Review, Sahni and colleagues highlight the renal problems associated with current chemotherapeutic agents and describe preventive strategies that can reduce the risk of renal complications in patients receiving these agents.
The fact that numerous systemic and renal disorders result in progressive proteinuria illustrates the importance of the glomerular filtration barrier. In this concise Review, authors from Stockholm provide an update on the structure and function of the glomerular filtration barrier and the pathogenesis of proteinuria, with a particular emphasis on the involvement of podocytes. The discussion encompasses newly identified pathogenic players, including TRPC6, phospholipase C ε, MYH9 and the urokinase receptor.
The nephrologist must consider several difficult questions when faced with a patient who has a new diagnosis of idiopathic membranous nephropathy (IMN). Here, authors from the National Institutes of Health corral the latest trial data to provide an update on the 'who', 'when' and 'how' of IMN treatment. They focus particularly on agents that have been studied as alternatives to cytotoxic drugs and ciclosporin, including mycophenolate mofetil, rituximab and adrenocorticotropic hormone.
Zuber and colleagues from Paris describe a case of diabetes that developed after renal transplantation in a young, white, nonobese man. Genetic screening detected a newly described deletion in the gene encoding hepatocyte nuclear factor 1 homeobox B,HNF1B, indicating that mutations in HNF1Bmight account for some 'unexpected' cases of new-onset diabetes after transplantation. Minimization of tacrolimus exposure and withdrawal of steroids markedly reduced the patient's insulin requirement.
