Nephrology Dialysis Transplantation 2007 22(5):i; doi:10.1093/ndt/gfm262
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In this issue ...
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Prorenin and the (pro)renin receptor: an update
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Prorenin is released constitutively from the kidneys and its
blood levels are
10-fold higher than those of renin. In microalbuminuric
diabetic subjects and pregnant women, prorenin is disproportionally
increased compared with renin. The origin and main functions
of prorenin are being discussed. The second part focuses on
the role of the (pro)renin receptor. Recently, (pro)renin receptor
antagonists have been designed which bind to the receptor instead
of prorenin. A number of direct angiotensin-independent effects
of prorenin are known. For example, beneficial effects of (pro)renin
receptor antagonists on diabetic nephropathy were observed in
AT
1 receptor-deficient mice. In addition, over-expression of
the human (pro)renin receptor in rats results in hypertension,
unaccompanied by changes in plasma renin activity or tissue
AII content.
See Danser et al., pages 1288–1292
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Is there a future for costimulation blockade?
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Recent phase II and phase III trials with belatacept, a re-engineered
CTLA4Ig, are briefly summarized. The interaction between costimulation
blockade and T-regulatory cells is also discussed.
See Vincenti, pages 1293–1296
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The association of an aldosterone blocker and an ACE inhibitor additively suppresses renal TGF-ß and NADPH oxidase in Dahl salt-sensitive rats with heart failure
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The increased glomerulosclerosis and proteinuria in these rats
with heart failure was reduced by this treatment. Eplerenone
was more powerful in the suppression of renal TGF-ß
than ACE inhibition alone.
See Onozato et al., pages 1314–1322
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Platelet-derived growth factor PDGF-D is widely expressed in fibrotic kidneys
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A PDGF-D neutralizing fully human monoclonal antibody administered
after the phase of acute glomerular damage exerts beneficial
effects on the course of tubulointerstitial damage, i.e. the
final common pathway of most renal diseases.
See Boor et al., pages 1323–1331
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The traditional management of children with proteinuric kidney disease is treatment with high dose steroids regardless of comorbid conditions, such as obesity
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In this study in 17 children (mean age 11.2 years), the treatment
with an ACEI and/or angiotensin receptor blocker alone led to
a significant decline in proteinuria after 3–6 months
with further decline with longer duration of treatment. The
eGFR decreased from ‘hyperfiltration’ levels before
to normal at the end of the treatment. Systemic blood pressure
remained normal. This therapy may provide an alternative to
more ‘toxic’, especially corticosteroid containing
therapies.
See Chandar et al., pages 1332–1337
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The occurrence of membranous nephropathy-following allogeneic haematopoietic stem cell transplantation is rare
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In French university and general hospitals, only five patients
were identified. All had a history of graft-
vs-host disease
with active manifestations at diagnosis of membranous nephropathy.
On biopsy, IgG1 and IgG4 were the predominant IgG subclasses
in the glomerular deposits. The treatment consisted of corticosteroids
and immunosuppressors; the nephrotic syndrome complete remission
occurred in two patients while partial remission was observed
in one.
See Terrier et al., pages 1369–1376
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Endothelial injury via angiotensin II may mediate a hyperplastic and prothrombotic response in PTFE grafts
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A retrospective evaluation of 266 accesses in four dialysis
centres found that ACEI use was associated with prolonged patency
of the grafts. ACEI had little or no effects on primary patency
of an AV fistula.
See Sajgure et al., pages 1390–1398
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A Markov model estimated the incremental cost-utility of cinacalcet in the UK
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This study revealed that this drug was only likely to be considered
cost-effective if the relative risk of mortality for people
with very high levels of PTH were 2.2 compared with people whose
PTH reached target levels, or if drug costs were considerably
reduced.
See Garside et al., pages 1428–1436
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Is there a future...