Review Articles in 2011

Infection is one of the most common causes of morbidity, mortality and hospitalization in patients undergoing dialysis. This Review focuses on the epidemiology and characteristics of access-related infections—bloodstream infections in hemodialysis and peritonitis in peritoneal dialysis—as well as access-unrelated infections, such as viral hepatitis and respiratory infection.

Urolithiasis is a common disorder that has several metabolic risk factors, most notably hypercalciuria. Genetic variants associated with urolithiasis have been identified from linkage and candidate gene studies, as well as from the first genome-wide association study of this condition, highlighting the role of several proteins in disease development and progression. In this Review, Monico and Milliner summarize the findings from studies that have advanced the understanding of the genetic basis of urolithiasis.

Diuretics are commonly used in the treatment of patients with chronic kidney disease. However, many questions remain regarding this practice, such as how best to combine diuretics and whether loop diuretics can be used in patients on hemodialysis. In this Review, Dominic Sica addresses these and other important questions surrounding the use of diuretics in patients with renal disease.

Genome-wide association studies (GWASs) have led to the identification of genes underlying renal traits such as glomerular filtration rate, and improved our understanding of the pathogenesis of chronic kidney disease. In this Review, O'Seaghdha and Fox discuss how GWASs have revolutionized genetic research, using several large-scale studies as examples, and explain how the knowledge derived from these studies can be applied to improve our understanding of the pathogenesis of kidney disease and to identify novel therapeutic targets.

New-onset diabetes mellitus after kidney transplantation (NODAT) is associated with increased morbidity and mortality, as well as poor quality of life. NODAT is likely to become more common in the transplantation setting as patient and graft survival improves. In this Review, Sharif and Baboolal provide specific guidance on diabetes mellitus-related complications in patients who have had renal transplantation.

The podocyte is a key target of injury in a number of renal diseases. Although some current therapies—including glucocorticosteroids and calcineurin inhibitors—have potent effects on the podocyte, their effects are nonspecific and lead to unwanted systemic adverse effects. In this Review, Peter Mathieson describes how advances in our understanding of podocyte biology has enabled the identification of potential therapeutic targets that may be able to prevent or limit podocyte injury and/or promote podocyte repair or regeneration.

Biomarkers have the potential to refine prognosis, improve risk stratification and guide therapy in patients on hemodialysis. The authors of this Review discuss the validation and potential use of biomarkers, including markers of chronic kidney disease-related mineral and bone disorders, markers of protein–energy wasting and inflammation, and markers of cardiovascular disease, in patients on hemodialysis. The authors also describe how proteomics can be used to identify and study new biomarkers.

Patients with acute kidney injury (AKI) complicating multiple myeloma often have poor outcomes. In this Review, Hutchison et al. discuss the pathogenic role of monoclonal free light chains in inducing proximal tubular damage and cast nephropathy in patients with multiple myeloma. The authors also provide an update on the diagnostic approaches to patients with AKI complicating multiple myeloma.

An understanding of the intricacies of cytoskeletal dynamics and regulation in podocytes is essential to facilitate investigation and treatment of patients with glomerular disease. This Review outlines the most recent concepts and advances in podocyte biology, and discusses how an improved understanding of the podocyte cytoskeleton is starting to shape advances in delineating the pathogenesis of common glomerular diseases.

Metabolomics—the nontargeted measurement of all metabolites produced by the body—holds promise for early diagnosis, increased choice of therapy and the identification of new metabolic pathways that could potentially be targeted in kidney disease. This Review discusses the techniques used in metabolomics and explores the limitations and future applications of this process.

Renal fibrosis is the common final outcome of almost all chronic kidney diseases, and can predict prognosis and determine renal insufficiency. This process consists of four overlapping phases: priming, activation, execution and progression. In this Review, Youhua Liu outlines the cellular and molecular mechanisms of renal fibrosis, which could help the development of new therapeutic strategies.

Lupus nephritis is one of the most common serious manifestations of systemic lupus erythematosus (SLE). Antimalarial agents are part of the immunomodulatory regimen used to treat patients with SLE, but the role of antimalarial agents in the treatment of lupus nephritis has been underappreciated by nephrologists. In this Review, the authors discuss the use of chloroquine and hydroxychloroquine in the treatment of patients with SLE, focusing on those with lupus nephritis.

Control of bone and mineral homeostasis is essential in children with chronic kidney disease to prevent skeletal complications, achieve adequate growth and maintain cardiovascular health. This Review describes the pediatric aspects of chronic kidney disease mineral and bone disorder and discusses the potential of the latest therapeutic agents.

Peritoneal dialysis is the preferred dialysis modality for most children with end-stage renal disease. Although advances in treatment have led to increased technique and patient survival, challenges remain. In this Review, Schaefer and Warady discuss data from multiple pediatric dialysis registries and describe the technical issues associated with peritoneal dialysis in pediatric patients.

After many years of research, poor growth remains a problem for children with chronic kidney disease. Causes are multifactorial, and include malnutrition, cachexia, hematological factors, endocrine problems and metabolic abnormalities. The Review focuses on the impact of inadequate nutrition on growth disturbances in children with chronic kidney disease, and discusses all aspects of the epidemiology, causes and potential treatments.

Cardiovascular disease is the main cause of death in children with chronic kidney disease, as these patients have a high prevalence of traditional and uremia-related risk factors for cardiovascular disease. This Review discusses the vascular and cardiac adaptations that occur in these patients, the pathological factors that stimulate these alterations and the consequences for cardiorespiratory fitness and physical functioning.

Most patients who are on dialysis require an oral phosphate binder; however, in the absence of robust data from clinical trials, guidelines on the ideal levels of phosphate in these patients are limited. This Review discusses the pharmacology, efficacy and safety of the available phosphate binders, and the problems associated with each binder.

Pediatric patients with end-stage renal disease (ESRD) usually receive dialysis treatment before undergoing transplantation. The development of dialysis programs in specialized pediatric nephrology units has led to the improved survival and rehabilitation of children with ESRD. The authors of this Review discuss the various medical, surgical, nutritional and psychosocial factors that need to be considered in order to provide optimal hemodialysis to children with ESRD.

Anemia in children with chronic kidney disease (CKD) is associated with increased morbidity and mortality. In this Review, Atkinson and Furth outline the adverse effects associated with the anemia of CKD in children and discuss factors that contribute to the development of anemia in this population. Treatment strategies and the challenges of managing this condition in children with CKD are also discussed.

Elderly patients with end-stage renal disease (ESRD) have a number of unique features that impact on the management of this condition. In this Review, Brown and Johansson highlight factors that need to be considered when treating elderly patients with ESRD. The authors also discuss the advantages and limitations of dialysis modalities in elderly patients with ESRD as well as the option of conservative care.