Volume 6 Issue 9, September 2010

A recent randomized clinical trial concluded that implantation of a stent graft plus angioplasty was superior to angioplasty alone for the treatment of stenosis at the venous anastomosis of an arteriovenous graft. However, concerns regarding the reliability of the results of this trial suggest that additional investigations are necessary.

The management of patients with hemolytic uremic syndrome is challenging, and strategies for accurate diagnosis and effective treatment are needed. Intensive research over the past several years has revealed dysregulation of the complement system to be the main underlying cause of the syndrome, making this system the target of promising novel diagnostic and treatment strategies.

Low pre-dialysis blood pressure is associated with an increased risk of mortality, but whether a high blood pressure level affects outcomes among patients on dialysis—as it does in the general population—is unclear. A recent study has found that higher systolic blood pressure measurements obtained outside the dialysis unit are associated with an increased risk of death, but that standard blood pressure recording in the dialysis unit has limited usefulness as a prognostic indicator.

A new pathologic classification scheme for diabetic nephropathy, in which only glomerular lesions are used to classify renal damage associated with either type 1 or type 2 diabetes, has been developed in association with the Renal Pathology Society. Given the heterogeneity of the renal lesions underlying diabetic nephropathy and the complex natural history of the disease, this scheme is not yet ready for clinical application but should be considered an important first step towards the development of a clinically useful classification system.

Many immunosuppressive agents used in renal transplantation are associated with an increased risk of cancer, and malignancy is the third most common cause of death among renal transplant recipients at all time points after transplantation. In this Review, Rama and Grinyó describe the epidemiological and clinical characteristics of common tumor types that occur in renal transplant recipients. They also discuss the potential pathogenic mechanisms involved in tumor development in these patients, with a particular focus on the involvement of immunosuppressive treatments.

Although continuous renal replacement therapy (CRRT) is widely used for the treatment of acute kidney injury in intensive care units, controversy in the clinical application of this therapy continues. Results of two recently published randomized controlled trials—the ATN study and the RENAL trial—have now provided an unparalleled quantity of information to guide clinicians. Here, Prowle and Bellomo discuss the results of these trials, explain the controversies that still exist regarding the use of CRRT, and describe the questions that remain to be answered.

Autosomal dominant polycystic kidney disease is a common disorder that is caused by mutations inPKD1 and PKD2. The proteins that these genes encode, polycystin 1 and polycystin 2, are thought to be involved in the sensing of shear stress and pressure through the regulation of calcium influx, nucleotide release and purinergic stimulation. This Review summarizes our current understanding of the role of polycystins in mechanosensory transduction and describes the potential role of altered mechanosensory transduction in the etiology of polycystic kidney disease.

Various molecules, such as components of the slit diaphragm and the glomerular basement membrane strictly orchestrate the integrity of the glomerular filtration barrier. Genetic defects in these components have the potential to cause glomerular disease. In this Review, Chiang and Inagi summarize genetic abnormalities that affect the structural and functional integrity of the glomerulus. The authors also discuss some of the therapeutic avenues that are being explored for the treatment of genetic forms of glomerular disease.

This article considers the case of a 52-year-old man who presented with life-threatening anion gap metabolic acidosis after drinking a large quantity of vodka. The authors discuss the role of thiamine deficiency in the development of severe lactic acidosis in alcohol-dependent individuals and conclude that early intervention can lead to excellent outcomes.