Articles in 2015

A new meta-analysis shows that dual blockade of the renin–angiotensin system is the most effective approach to prevent end-stage renal disease in patients with diabetes and kidney disease. Combination therapy should therefore be reconsidered as the most powerful tool for nephroprotection, provided that treatment is individually tailored by careful dose-titration.

Cell therapy holds promise to enable efficient repair of the adult human kidney, which could reverse damage caused by repeated renal injury. In this Review, Bussolati and Camussi consider the latest evidence for the existence and origin of functional renal progenitor cells in adult humans and the role of these cells in renal repair. They then discuss strategies for generating renal progenitor cells from pluripotent stem cells, human fetal cells and adult renal cells that could be used for cell therapy.

A randomized multicentre controlled study of 240 cardiac surgery patients at high risk of acute kidney injury (AKI) has demonstrated that remote ischaemic preconditioning can reduce the rate of AKI and requirement for renal replacement therapy. These findings suggest this procedure could be a promising therapeutic option for this high-risk patient group.

Elevated levels of fibrobast growth factor 23 (FGF-23) are associated with cardiovascular and all-cause mortality in patients with kidney disease. A secondary analysis of the EVOLVE trial reports that cinacalcet-induced reductions in FGF-23 were associated with a reduced risk of cardiovascular events in patients with secondary hyperparathyroidism on dialysis.

The constitutive uptake and degradation of filtered albumin by the proximal tubule has resulted in this process being relegated a passive player in albuminuria. Real-time intravital imaging of the rat kidney now describes a new paradigm in which the proximal tubule dynamically increases or decreases albumin uptake following changes in plasma albumin levels.

Human adult stem or progenitor cell organoid cultures have been established for multiple organs and have proved valuable in the basic study of pathophysiology as well as in clinical applications. Such an organoid culture system has not yet, however, been developed for the kidney. Here the authors describe the development and application of the available adult stem or progenitor cell organoid cultures, the challenges and feasibility of developing such a system for the kidney, and the potential kidney-specific applications of organoids.

The association between hypertension and chronic kidney disease is cyclic and complex. In this Review, Townsend and Taler discuss the underlying mechanisms of this association and emphasize the importance of achieving and maintaining adequate blood pressure control in renal disease. They outline the necessity of accurate blood pressure monitoring, the value of drug and non-drug therapies, and assess the current blood pressure targets recommended by different guidelines for patients with chronic kidney disease.

Maintaining steroid-free remission in children with idiopathic nephrotic syndrome is an important goal of therapy. A new trial provides evidence that mycophenolate mofetil can be added to the list of effective steroid-sparing agents. The majority of participants relapsed, however, highlighting an unmet need for more effective treatment modalities.

A new study reports that state-level policies have had little effect on rates of organ donation in the USA, highlighting the limited ability of scattered initiatives to have a national effect. Regardless of their impact on donation rate, a need exists for policies that make donation financially neutral for donors.