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According to the Kidney Disease Outcomes Quality Initiative guidelines, estimated glomerular filtration rate can be used to diagnose chronic kidney disease. The authors of this Viewpoint argue, however, that reliance on estimated glomerular filtration rates alone encourages an erroneous disregard of age, gender and other evidence of kidney disease, such as proteinuria. Consequently, mandatory reporting of estimated glomerular filtration rate leads to misdiagnosis of chronic kidney disease and to the unhelpful referral of healthy individuals to nephrologists.

Strategies for the management of hypertension in patients with type 2 diabetes mellitus are controversial. New data from a landmark meta-analysis support the use of antihypertensive therapy in these patients but the impact of blood pressure-lowering on albuminuria and progression of chronic kidney disease remains unclear.

Encouraging preliminary data from the NEFIGAN trial suggest that a novel oral formulation of budesonide might reduce disease progression in IgA nephropathy. This formulation releases corticosteroid in the distal small intestine and colon, so is thought to directly target the mucosal element of the pathogenesis of the disease.

The randomized, controlled IDEAL study reports no survival advantage of 'early' dialysis initiation and data from this study support an estimated glomerular filtration rate of around 7 ml/min/1.73 m² as a guideline for dialysis initiation. The results of the IDEAL study supplement data from eight observational studies involving over 1.2 million patients which showed a comorbidity-adjusted incremental survival disadvantage of 'early' dialysis initiation.

Transdermal detection of fluorescent markers has potential to provide point-of-care measurement of glomerular filtration rate. However, validation of proposed approaches and confirmation of their clinical utility should be required ahead of their adoption in the clinic.

Cystatin C continues to show its superiority over serum creatinine in predicting mortality among patients with chronic kidney disease (CKD). This superiority is, in part, due to the non-glomerular filtration rate (GFR) determinants of cystatin C associating with CKD risk factors and outcomes. The definition and classification of CKD should not exclusively equate cystatin C with GFR.

The use of cystatin C-inclusive equations will continue to propagate the unnecessary overdiagnosis of chronic kidney disease (CKD) in older people. Cystatin C is less biologically specific for CKD than is serum creatinine, inflates the risks of adverse outcomes compared to measured glomerular filtration rate, and does not establish chronicity at a single time point.

Optimal referral of patients who are at risk of kidney failure to nephrologists could improve their long-term outcomes. Various strategies, including the inclusion of kidney failure risk equations in electronic medical records and the active dissemination of clinical practice guidelines, could help to reduce the gap between optimal referral and what currently happens in clinical practice.

A reduction in proteinuria and albuminuria has long been proposed as a surrogate biomarker for clinically validated end points for interventional trials in patients with kidney disease. Taken together, the findings of two recent landmark meta-analyses present a formidable argument favouring such surrogacy but some uncertainty remains.

Estimates of the prevalence of chronic kidney disease (CKD) vary widely, both within and between countries. Here, the authors discuss the origins of this variation, particularly issues relating to the use of estimated glomerular filtration rate, and present solutions for tackling the factors responsible.

Current treatment recommendations for lupus nephritis are largely guided by the 2003 International Society of Nephrology/Renal Pathology Society classification system. Here, the authors discuss potential approaches by which this classification system could be improved through consideration of underlying disease processes characterized by the presence of glomerular crescents, podocyte injury, tubulointerstitial lesions and vascular injury.

Focal segmental glomerulosclerosis is a histopathological lesion that has heterogeneous causes. In this Perspectives article, the authors outline a rationale for the stratification of focal segmental glomerulosclerosis based on current understanding of the pathophysiology of podocyte stress and damage and propose that such an approach will improve the rational design and success of therapeutic trials.

Chronic kidney disease (CKD) is the progressive, irreversible loss of renal function that has many causes and contributing factors. In this Primer, the authors describe the many consequences of CKD and how understanding — and treating — the underlying cause can substantially slow CKD progression.

Although IgA nephropathy is a common primary glomerulonephritis, its exact pathogenesis is not well defined. In this Primer, Lai et al. report a broad overview of the disease, from pathogenesis to therapy.