In This Issue
A late 2007 issue of the Annals of Internal Medicine (Ann. Intern. Med. 2007; 147: 840-853 and contained a meta-analysis from the Renal Cochrane Group, and two editorial comments questioning the evidence of the systematic prescription of vitamin D compounds to CKD patients and to patients on dialysis. A somewhat provocative editorial comment in this issue by Olgaard and Lewin criticized some of the statements in the contributions in the Annals and the editorial office of NDT thought it appropriate to ask for a reaction by the authors of these papers. Our readers will certainly enjoy reading this discussion.(See editorial by Olgaard et al., pages 1786–1789; reply by Palmer et al., pages 1789–1792 and reply by Tonelli, pages 1792–1793)
The current treatment regimes for patients with nephrotic syndrome due to idiopathic membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) are based on steroids and/or cytotoxic agents. Treatment of adults with steroid-dependent minimal change nephrotic syndrome can be a significant challenge. Two papers discuss the role of mycophenolate mofetil and tacrolimus in these situations. These studies are commented on in a thoughtful editorial.
(See editorial by Coppo, pages 1793–1796; article by Li et al., pages 1919–1925 and article by Nayagam et al., pages 1926–1930)
Conflicting results have currently been published on the advantages or disadvantages of a tight regulation of glycaemia in patients with type 2 diabetes mellitus. It is appropriate that two of these studies, ACCORD and ADVANCE, showing opposing results, are put in the correct perspective in this issue by our diabetes subject editor L. Gnudi, together with his co-author J. Karalliedde.
(See editorial by Karalliedde et al., pages 1796–1798)
GFR values are conventionally ‘normalized’ to body surface area (BSA), but theoretically scaling the values to extracellular fluid volume (ECV) would perhaps be more accurate. This study in volunteers found that, measured with Cr-51-EDTA, as frequently used in Europe, GFR normalized to ECV was as reproducible as GFR normalized to BSA. Iohexol appeared to be less reliable when scaled down to ECV, particularly after food intake.
(See article by Bird et al., pages 1902–1909)
Tissue inhibitor of metalloproteinase-1 (TIMP-1) is associated with renal fibrosis; furthermore, it is a multi-functional protein, but other roles in renal fibrosis are unknown. A nice experimental study demonstrated that overexpression of TIMP-1 could promote renal interstitial fibrosis through inflammatory pathways, which might be partly induced by upregulating ICAM-1.
(See article by Cai et al., pages 1861–1875)
Long-term rHuEpo treatment may be associated, in most patients, with persistent iron deficiency in spite of oral iron supplementation. Abnormalities of iron absorption and transport in the duodenum may contribute to this deficiency. In adenine-induced renal failure in rats, rHuEpo treatment improved renal anaemia and induced iron deficiency. The expression of mRNAs of molecules related to iron metabolism, like ferroportin 1 and hephaestin 1, increased while that for divalent metal transporter 1 (DMT1) was unchanged. In contrast, control rats treated with rHuEpo showed no such alterations. Hepcidin mRNA expression was greater in adenine rats than in control rats. These findings may, at least partially, explain the iron deficiency induced by erythropoietin.
(See article by Hamada et al., pages 1886–1891)
Stage 5 chronic kidney disease (CKD) is associated with enhanced aortic calcification. Administration of indoxyl sulphate, a known uraemic toxin, induced aortic calcification with the expression of osteoblast-specific proteins and aortic wall thickening. Indoxylsulphate is thus not only a nephrotoxin but also a vascular toxin.
(See article by Adijiang et al., pages 1892–1901)
Home haemodialysis (HHD) and self-care satellite dialyses (SHD) have been suggested to offer significant benefits over conventional in-centre haemodialysis. A study analysed the costs and health-related quality of life (HRQoL) in both modalities. HHD and SHD are, from the patient's perspective, equally effective in providing better health and the total costs were similar. However, in the HHD setting, patients had, on average, more and longer sessions.
(See article by Malmström et al., pages 1990–1996)
Post-transplant diabetes mellitus (PTDM) has serious consequences for renal allograft survival, cardiovascular risk and patient survival. In a study presented in this paper, it appears that the oral glucose tolerance test on day 5 post-transplantation is an independent predictor of PTDM, and that it can be used for identifying recipients at reduced risk for PTDM, taking into account the impact of independent clinical risk factors like age, BMI and treatment for biopsy-proven acute rejection.
(See article by Kuypers et al., pages 2033–2042)
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