Volume 8 Issue 10, October 2012

For more than 20 years, Doppler ultrasound has been a valuable noninvasive imaging tool in the evaluation of several forms of kidney disease. Modifying the typical parameters used in clinical practice as shown in a study by Grün et al. may lead to a more kidney-specific Doppler value.

German health-care providers should be applauded for their heroic efforts in facing the 2011 Escherichia coli O104:H4 outbreak. However, a unique opportunity was missed to compare the efficacy of antibiotics, plasma therapy and eculizumab therapy in a randomized study, and the open questions concerning the optimal treatment of severe Shiga-toxin-associated haemolytic uraemic syndrome remained unanswered.

The link between chimerism and tolerance is well established. In a rhesus macaque study, Ramakrishnan et al. show that the type of chimerism might have an important effect on tolerance to kidney allografts, pointing to a critical role of donor T-cell production for success. These findings could directly impact clinical efforts to induce tolerance to allografts.

Abramowitz et al. report that the albumin-adjusted and full anion gaps are independent predictors of all-cause mortality after adjusting for estimated glomerular filtration rate (eGFR). This finding raises the question as to whether subtle changes in tubular function could identify patients at increased risk of adverse outcomes, even in those with eGFR >60 ml/min/1.73 m².

Ongoing research continues to show only moderate accuracy of all methods of measuring proteinuria in pregnant women with hypertension. We need to change traditional thinking so that emphasis on the detection or quantitation of proteinuria is not greater than emphasis on other clinical or laboratory features in the diagnosis or management of pre-eclampsia.

Current dogma suggests that fluid overload—when associated with acute kidney injury (AKI)—is an independent risk factor for death. Although the volume status of the patient is important, there are other predictors of morbidity, mortality and the need for renal replacement therapy in patients with AKI.

Studies of the association between BMI and complications after transplantation have reported variable results. BMI may be a deficient measure of obesity; therefore, a better measure of obesity and improved definition and follow-up of complications related to obesity may strengthen the estimation of post-transplantation risk in obese patients.

Atrial fibrillation and chronic kidney disease (CKD) frequently coexist and confer an increased risk of stroke. Novel anticoagulants are attractive options over warfarin but undergo renal clearance to varying degrees, and therefore require special consideration in patients with CKD. Recent studies also challenge the benefits of warfarin anticoagulation for atrial fibrillation patients undergoing haemodialysis. This Review discusses the data relating to anticoagulation in patients with atrial fibrillation and CKD and highlights the need for further studies to delineate the optimal use of new anticoagulant agents in patients with CKD.

Home haemodialysis offers increased flexibility over in-centre haemodialysis for adopting different dialysis regimes aimed at improving solute removal. In this Review, Vanholder et al. discuss strategies that can improve haemodialysis adequacy in the home setting. The authors examine vascular access, reaching dialysis adequacy targets, increasing dialyser pore size, increasing dialysis frequency, and increasing dialysis duration, and also discuss the idea of the wearable artificial kidney.

Acute metabolic acidosis is common in seriously ill patients, and is associated with increased morbidity and mortality. Rapid recognition of this acid–base disorder and provision of effective therapy are, therefore, essential. This Review summarizes current approaches to the treatment of acute metabolic acidosis, highlights the evidence for and against base therapy, and discusses the potential benefits of newer targeted therapies.

Hypertension is a leading cause of morbidity and mortality and the kidney has a pivotal role in this condition by regulating arterial blood pressure. In this Review, Wadei and Textor provide examples of the regulatory mechanisms that are involved in controlling blood pressure and discuss how disorders that affect the kidney contribute to hypertension.