Articles in 2010

The possible cardioprotective and renoprotective effects of statins in patients with chronic kidney disease remain an unsolved enigma for clinicians and researchers in the field of nephrology. Do the recently published AURORA and JUPITER studies shed light on this controversy?

Non-melanoma skin cancer occurs at an alarmingly high rate in transplant recipients, causing considerable morbidity and sometimes even mortality. A recent prospective clinical study performed by nephrologists and dermatologists at the Johann Wolfgang Goethe University in Frankfurt suggests that switching renal transplant recipients with skin lesions onto the mTOR inhibitor sirolimus might keep non-melanoma skin cancer in check.

Prerenal azotemia is a common occurrence in hospitalized patients and is generally easier to define in clinical practice than in clinical research. Monitoring the duration of acute kidney injury and biomarkers of kidney function might help distinguish prerenal azotemia from acute tubular necrosis in both clinical practice and research settings.

The Oxford classification of IgA nephropathy identified four histological features with adequate reproducibility and clinical relevance to predict renal outcome in patients with IgA nephropathy. Does the predictive value of biopsy lesions apply across a range of patient ages?

The clinical management of chronic kidney disease leads to an inevitable interplay between recommended therapies and the hazards of impaired renal function. Disturbances in potassium level are a common byproduct of this interaction and can increase the risk of adverse safety outcomes in patients with chronic kidney disease.

Changes in serum creatinine concentration are used to define acute kidney injury after the intravascular administration of iodinated contrast media, but less is known about the short-term increases in levels of cystatin C after angiography. A new study investigates whether cystatin C is a reliable marker of contrast-induced acute kidney injury after angiography.

Cytomegalovirus (CMV) infections are among the most common infections that can occur following solid organ transplantation. Although overall awareness of CMV disease has improved, several challenges remain with regards to its management. In this Review, Camille Kotton provides an overview of CMV diagnostics, methods for the prevention of CMV infection, and progress in the management of this disease.

The prevalence of cardiovascular disease is high in patients with chronic kidney disease (CKD), especially in those with end-stage renal disease. In this Review, Drüeke and Massy discuss the contribution of atherosclerosis to the development of cardiovascular disease in patients with CKD and describe data from clinical, imaging, morphological and experimental studies that provide evidence for atherogenesis as CKD progresses.

Increased uric acid has often been associated with pre-eclampsia in pregnant women, an issue re-examined in this Perspective by Martin and Brown. The authors call for further examination of the relationship between maternal plasma uric acid levels and maternal endothelial dysfunction and utero-placental bloodflow in pre-eclampsia, and suggest that uric acid is a pathogenic amplifier of this condition.

Iron deficiency is common in patients with chronic kidney disease (CKD) and administration of iron supplements could help maintain target levels of hemoglobin and reduce, or remove, the need for erythropoiesis-stimulating agents. In this Review, Besarab & Coyne discuss the efficacy, safety and practical recommendations for oral and intravenous therapy in the treatment of anemia in patients with CKD.

Hereditary disorders of renal phosphate wasting are rare genetic diseases. Affected patients can be symptomatic during childhood or adulthood, depending on the disease entity. In this Review, Alizadeh Naderi and Reilly provide an overview of a number of renal phosphate wasting disorders, focusing on their mode of inheritance, the effect of the responsible mutation, and clinical symptoms.

Contrast-induced acute kidney injury (CIAKI) is a leading cause of iatrogenic renal failure. Multiple studies have shown that patients with diabetic nephropathy who are exposed to contrast media are at high risk of CIAKI. This Review describes the pathogenesis of CIAKI in patients with diabetic nephropathy and discusses both currently available strategies and potential future strategies for CIAKI prevention.

Although living donor kidney transplantation is often presented as the best option for patients awaiting renal transplantation, patients whose renal failure is the result of an inherited disease might not be suitable candidates for transplantation from a living related donor. In this Review, Patrick Niaudet discusses hereditary nephropathies for which living donor kidney transplantation is a viable option as well as diseases for which living donor transplantation is contraindicated.

Tubulointerstitial hypoxia is increasingly recognized to have a key role in the progression of chronic kidney disease to end-stage renal disease. In this Review, Mimura and Nangaku discuss the different factors that contribute to the development of hypoxia in the tubulointerstitium and the susceptibility of different kidney cell types to hypoxia. Methods to detect hypoxia and potential therapeutic approaches to target chronic hypoxia in the kidney are also described.

Many clinical guidelines recommend thiazide diuretics as first-line treatment for hypertension, even in individuals with mild chronic kidney disease (CKD). However, results from the ACCOMPLISH trial add to growing evidence that thiazide-based therapy does not retard progression of CKD. Re-evaluation of the role of these agents in the management of hypertension in patients with CKD might be appropriate.

The results of a large observational study seem to confirm an association between early initiation of dialysis and increased mortality that is not fully explained by the presence of comorbidities and other confounding variables. However, this paradoxical association may be an artifact resulting from the inaccuracy of using plasma creatinine levels to estimate glomerular filtration rates in patients with severely impaired renal function.

Almost 25 years after recombinant human erythropoietin first became available to treat anemia in patients with chronic kidney disease, the optimal use of erythropoiesis-stimulating agents (ESAs) is as unclear as ever. One reason for this uncertainty is that the risks associated with correction of anemia using ESAs could be either related to patients' hemoglobin levels or to off-target effects of these agents.