Volume 7 Issue 8, August 2011

Results from the ROADMAP trial have highlighted the discrepancy between the renoprotective effects of olmesartan treatment in patients with type 2 diabetes mellitus, and the observed increase in cardiovascular deaths. Several explanations for these results need to be considered, which may influence future clinical practice.

Clinical practice guidelines recommend target serum levels for phosphorus, calcium and parathyroid hormone in patients with chronic kidney disease. However, a recent meta-analysis has found that only levels of phosphorus seem to be associated with the risk of death in these patients.

Genetic forms of steroid-resistant nephrotic syndrome are characterized by an unremitting clinical course, resistance to treatment and a favorable outcome after transplantation. The recognition of these diseases is essential, but difficult, owing to genetic and phenotypic heterogeneity. Such difficulties have led to the proposal of a systematic step-wise approach for mutational screening.

A recent study reports the expansion of the donor pool by using kidneys from donors after cardiac death with prolonged agonal time. The duration of the agonal period and hemodynamic instability do not influence kidney transplantation outcome, indicating that this approach is feasible and may help meet the need for donor kidneys for transplantation.

Hypertension is a major risk factor for the progression of chronic kidney disease (CKD) in adults and children, and existing evidence suggests that pharmacological intervention could slow the decline in renal function. In this Review, Wühl and Schaefer discuss the pathology of CKD progression, including the role of hypertension and proteinuria. The use of tight blood-pressure control to prevent progressive CKD and the various antihypertensive agents used in patients with CKD are also discussed.

This Review focuses on early detection of chronic kidney disease (CKD) and highlights its associations with cardiac disease and other comorbidities that contribute to poor outcomes. The authors describe the role of estimated glomerular filtration rate and albuminuria in identifying early CKD, examine the benefits of early CKD detection, and describe the limitations of current knowledge with respect to screening, early detection and treatment.

Genome-wide association studies have advanced our understanding of the genetic basis for common renal diseases. The ability to establish these associations raises the question of whether these discoveries offer help to patients with (or at risk of) renal disease. Here, Drawz and Sedor describe recent discoveries in relation to the genetic associations underlying common kidney disease and related disorders, and discuss the issues and challenges of translating these data into the clinic.

The traditional process of drug discovery and development is time-consuming and expensive. Exploratory clinical trials, which are carried out in humans at an early stage of drug testing, provide pharmacological information that can be used to reduce attrition rates and minimize preclinical testing. The authors of this Review describe the concept of exploratory clinical trials and highlight new investigational drugs that could benefit patients with kidney disease.

This article reports the case of a 50-year-old man who had undergone kidney and pancreas transplantation and developed pancytopenia following treatment with azathioprine. A genotype test for thiopurineS-methyltransferase (TPMT) showed that the patient was homozygous for TPMT^*3A, which accounted for the susceptibility to azathioprine-related myelosuppression. The authors discuss the importance of TPMT testing and describe the tools available for monitoring for adverse effects from treatment.