Articles in 2009

Atypical hemolytic uremic syndrome often progresses to end-stage renal disease and recurs after kidney transplantation, even with empiric plasma therapy. Guidelines on the treatment of this devastating disease have now been published, following a consensus conference in Bergamo, Italy.

As the population ages, more elderly people are developing kidney disease. Nephrologists are often reluctant to perform renal biopsy in elderly patients, but in many cases, the diagnostic benefits of this procedure outweigh the risks.

How long should we monitor patients for evidence of significant bleeding after percutaneous native kidney biopsy? Both cost and safety must be rigorously considered before recommending a new standard of care.

Uremic diabetics have better survival rates with a kidney transplant than on dialysis. Adding a pancreas graft induces insulin independence and if the graft survives for >1 year, risk-adjusted registry analyses show improved patient and graft survival. Overall, however, as survival is similar for kidney–pancreas and kidney transplants alone from deceased pancreas donors, many questions remain.

Graft stenosis, which can lead to thrombosis, is a major problem in hemodialysis patients with arteriovenous grafts. Does anti-aggregation with dipyridamole and aspirin help to prolong the primary patency of vascular access grafts?

The recent EUPHAS trial was stopped early because of reduced mortality in patients with sepsis treated with polymyxin B hemoperfusion. So should we rush to offer this technique to all patients with sepsis? Not quite so fast.

The new Oxford classification of IgA nephropathy has been developed as a pathological classification system to reliably predict the risk of disease progression. Future studies need to demonstrate the value of this classification in directing individualized therapeutic decisions for patients with IgA nephropathy.

Interferon, which is widely used to treat chronic hepatitis C virus infection, plays a critical role in the pathogenesis and perpetuation of certain autoimmune diseases, including systemic lupus erythematosus. In this Case Study, Agarwal and colleagues present the case of a patient on hemodialysis who experienced systemic lupus erythematosus exacerbation with cerebritis following treatment of her hepatitis C virus infection with pegylated interferon monotherapy.

Studies in Africa have reported differing prevalence rates of renal disease in HIV; however, extrapolation of US statistics suggests that between 770,000 and 2.6 million people in sub-Saharan Africa could have HIV-associated nephropathy. This Review provides a global overview of HIV-related kidney disease to set the scene for a detailed analysis of this issue in Africa. The authors proffer advice on how to prevent or slow progression of renal disease and outline options for renal replacement therapy.

The two most common forms of HIV-related renal disease are HIV-associated nephropathy and a collection of immunoglobulin-related glomerulonephritides known as HIV immune complex kidney diseases. In this Review, Bruggeman and Nelson discuss the pathogenesis of these two diseases focusing on topics that remain points of controversy, such as mechanisms of infection within the kidney, modeling of disease in rodents, the contribution of host immune responses, and the source of the proliferating glomerular epithelial cell.

The presence of HIV has historically been viewed as a contraindication to transplantation because of the risks associated with immunosuppression in patients who are already immunocompromised, the lack of long-term outcomes data to justify the use of a limited supply of donor organs, and the possibility of viral transmission to surgical staff. Frassetto and colleagues examine the issues surrounding kidney transplantation in patients with HIV and describe a range of strategies that optimize outcomes in these individuals.

Highly active antiretroviral therapy (HAART) has a variety of adverse renal effects. Patients receiving HAART can develop acute kidney injury, which can progress to chronic kidney disease. HAART also contributes indirectly to kidney disease by increasing the risk of diabetes and hypertension. This Review describes the epidemiology, mechanisms and diagnosis of HAART-related kidney damage, with an emphasis on the preventive management of risk factors such as intravascular volume depletion and pharmacological interactions.