Articles in 2015

The term 'hypertensive nephrosclerosis' is often used to define chronic kidney disease in non-diabetic patients with mild-to-moderate hypertension and low level or absent proteinuria; however, this terminology implies that the hypertension is causative of the kidney disease. Here, Barry Freedman and Arthur Cohen describe the differences between genetically mediated forms of glomerulosclerosis and arteriolar nephrosclerosis that is potentially related to hypertension and other vascular disease risk factors. They argue that the term 'hypertensive nephrosclerosis' should be replaced with terminology that better reflects the underlying disease aetiology, to improve diagnostic accuracy in this field.

A new study reports that addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to renin–angiotensin system (RAS) blockade resulted in a reduction in albuminuria in patients with diabetic nephropathy. Such a strategy might provide an opportunity to maximize the beneficial effects of RAS blockade without increasing the risk of hyperkalaemia.

Autosomal dominant polycystic kidney disease is a challenging disorder to diagnose and treat effectively. Promising research over the past decade has, however, provided novel interventions, modifications to clinical practice and new areas to investigate with the aim of identifying approaches to slow disease progression.

Albuminuria is used as a marker of kidney disease progression, but whether it has a role in the pathogenesis of kidney disease and the reasons for its association with cardiovascular disease are unclear. In this Review, Rabelink and de Zeeuw propose that degradation of the glycocalyx leads to albuminuria and that the filtered protein contributes to kidney disease pathogenesis. Furthermore, they discuss how systemic degradation of the gylcocalyx can lead to cardiovascular disease, providing an explanation for the association between these diseases and albuminuria.

Acute kidney injury (AKI) is highly prevalent in patients admitted to the intensive care unit, and many of these patients also develop concomitant respiratory complications. In this Review, Faubel and Edelstein discuss the traditional and non-traditional complications of AKI, focusing in particular on the pathologic mechanisms that underlie respiratory complications and the mediators of AKI-induced pulmonary inflammation.

In this Viewpoint, five members of theNature Reviews Nephrologyadvisory board reflect on the progress and frustrations of the past decade in basic and clinical nephrology research. They comment on areas where effort and money should be invested and the challenges that remain to be overcome, as well as give their predictions for progress in the next decade.

Dysregulated phosphate metabolism is a common consequence of kidney disease and renal transplantation. In this Review, Martin H. de Borst and colleagues outline the pathophysiology of dysregulated phosphate metabolism in renal transplant recipients and discuss the effect of this dysregulation on the cardiovascular system, bone, and the kidney graft. They also propose possible strategies to correct phosphate abnormalities in these patients.

Although the first 50 years of renal transplantation were marked by great advances in immunosuppressive therapies, the past decade has been marked by an unprecedented increase in technology. This progress has spurred investigators to challenge old paradigms and investigate how best to utilize these technologies to further improve patient care.