In This Issue
The physiology and pathophysiology of fat tissue should become a topic of major interest for the nephrologists. Adipose tissue is not only the largest endocrine gland in the body but adipokines are important uraemic toxins and fat is an important source of inflammation in CKD patients.See editorial comment by Axelsson, pages 3041–3046
Recent studies on calcium-containing versus non-calcium-containing phosphate binders (Renagel) may have created confusion among the practicing nephrologists. This editorial commentary summarizes some of these studies and concludes that, despite conflicting data, we should still take care to reduce oral calcium loading in patients with advanced CKD, in particular if cardiovascular calcifications have already been documented.
See editorial comment by Floege, pages 3050–3052
Treatment of pure red cell aplasia induced by erythropoiesis-stimulating agents is challenging. In an editorial comment, treatment protocols for patients suffering from PRCA are summarized and include immunosuppression, with resolution of the anti-erythropoietin (anti-EPO) antibodies and subsequent re-challenging with EPO.
See editorial comment by Summers et al., pages 3053–3055
In a discussion of the different renal replacement therapies in patients with lupus nephritis, haemodialysis is preferred over CAPD, especially if the patient is still using immunosuppressives. However, if possible, pre-emptive transplantation with a kidney from a living donor leads to the best results.
See editorial comment by Rietveld and Berden, pages 3056–3060
Haeme oxygenase (HO)-1 is considered to play a protective role in various disorders. In this experimental rat study of membranous nephropathy (MN), the efficacy of cobalt protoporphyrin (CoPP, a potent HO-1 inducer) as therapy for MN was assessed. Treated animals displayed a significant reduction in proteinuria and a marked amelioration of glomerular lesions, accompanied by attenuated immune-complex deposition. It was concluded that HO-1 induction therapy may ameliorate experimental MN via multiple pathways, including anti-oxidative, anti-apoptotic and immunomodulatory effects.
See article by Wu et al., pages 3082–3090
Shiga toxin (Stx) is the main pathogenic factor in the haemolytic–uraemic syndrome. Endothelial heparan sulfate proteoglycans (HSPG), and heparan sulfate in particular, play an important role in the inflammatory process by acting as a ligand for L-selectin. In this elegant in vitro study, Stx increased the amount of firmly adherent leukocytes in both human umbilical venous endothelial cells (HUVEC) and human glomerular endothelial cells (GMVEC). After removal of endothelial heparan sulfate, the number of adhering leukocytes decreased.
See article by Geelen et al., pages 3091–3095
The association of sirolimus (SRL) with calcineurin inhibitors is still a problem in clinical transplant practice. An experimental study found that the association of SRL with high doses of cyclosporine (CsA) or tacrolimus (Tac) produces a different functional, histological, inflammatory and pro-fibrogenic pattern. The addition of SRL to high doses of CsA leads to severe renal injury. The combination with high doses of Tac is clearly less deleterious in the short term.
See article by Lloberas et al., pages 3111–3119
An elegant clinical study examined the excretion of viable podocalyxin (PDX)-positive cells in a random set of spot urine from patients with several biopsy-proven glomerular diseases and characterized the excreted cells for podocyte and parietal epithelia markers as well as for proliferation activity. It was found that PDX-positive cells are lost in the urine in disease states that require podocyte regeneration and are a useful non-invasive marker for glomerular disease activity. These cells are possibly derived from the parietal epithelial layer.
See article by Achenbach et al., pages 3138–3145
Treatment with angiotensin receptor blockers (ARBs) is well accepted as a treatment in patients with hypertension and type 2 diabetic nephropathy. A multicentre trial found that the renoprotection afforded by telmisartan and valsartan appears similar, and there was no effect beyond that due to blood pressure control. At doses used to treat hypertension, there was no evidence of inflammatory parameters being modified by ARBs in these patients.
See article by Galle et al., pages 3174–3183
For the diagnosis of coronary artery calcification (CAC), high-resolution computerized tomography (HRCT) is often used but data on the reliability and validity of in patients with CKD is lacking. This clinical study found a significant imprecision in HRCT-derived CACS in CKD patients and the data suggests a need for standardization of methods of CACS measurement with HRCT.
See article by Barraclough et al., pages 3199–3205
Osteoprotegerin (OPG) is a marker and regulator of arterial calcification, and it is related to cardiovascular survival in haemodialysis patients. This study found that OPG is strongly related to pulse wave velocity (PWV) and further demonstrated that OPG-related cardiovascular mortality risk is, in part, mediated by increased PWV.
See article by Speer et al., pages 3256–3262
Haemodialysis is much more frequently used to start renal replacement therapy in an unplanned patient due to late referral. This French study found, however, that peritoneal dialysis is a safe and efficient alternative to haemodialysis for unplanned dialysis patients; PD offers the advantage of reducing the need for tunnelled catheter in unplanned dialysis patients.
See article by Lobbedez et al., pages 3290–3294
The degree of international variation in the process of informed consent of potential living kidney donors during their evaluation was assessed in a survey among US and non-US respondents. Compared to non-US respondents, US respondents were more likely to use written material and visual aids to convey risks to donors, have mandatory psychosocial evaluations and provide access to donor support groups. US transplant centres also discussed more the possibility of the donors needing dialysis or a transplant if their remaining kidney fails in the future.
See article by Parekh et al., pages 3316–3324
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