In This Issue
An interesting editorial comment on the pro's and con's of maximal suppression of the RAAS system in patients with chronic kidney diseases concludes that the majority of patients probably attain their optimal therapeutic response at standard doses of either ACE inhibitors or ARBs or combinations of these drugs, but that a small residual group has further therapeutic benefit of high doses. Since these patients are not a priori identifiable, a temporary trial at higher doses of these drugs seems cogent in order to provide more robust antiproteinuric benefit to such patients. The cost of doing so, in terms of side effects, is low and warrants this approach.See editorial comment by Berl, pages 2443–2447
A thoughtful editorial describes how the recent development of reproducible, quantitative assays for serum and urinary hepcidin in the future may define its role in predicting and monitoring the response to ESA and iron treatment in patients with CKD in comparison with more conventional parameters. In addition, hepcidin might also become a target of therapy, since lowering hepcidin may aid in improving gastrointestinal uptake of iron and its release from macrophages, thus limiting the need for i.v. iron, overcoming functional iron deficiency, and improving ESA resistance.
See editorial comment by Swinkels and Wetzels, pages 2450–2453
An in-depth clinical review describes the early identification of risk factors of chronic allograft nephropathy (CAN) which may prompt early intervention, with clinicians making changes to immunosuppressive regimens which may improve the outcomes of CAN. This review also describes several combinations of immunosuppressor regimens which, through minimising the use of CNIs, can maintain a low level of acute rejection, also by reducing smooth muscle cell proliferation within the kidney. In addition, a CNI-free regimen utilising mycophenolate therapy alone, or in combination with a PSI, may result in an improvement in renal function and graft survival without increasing the risk of acute rejection in patients with CAN.
See editorial review by Serón et al., pages 2467–2473
Dendrin is a cytosolic protein associated with the actin cytoskeleton, and has been found in foot processes of mouse glomerular podocytes. This article describes the expression of dendrin during glomerulogenesis and in the normal human kidney, similar to that previously shown for nephrin, which suggests that dendrin associates with the slit diaphragm complex. In minimal change nephritic syndrome, dendrin is re-distributed within the podocytes.
See article by Dunér et al., pages 2504–2511
The evolution of large-vessel arteriopathy was studied in a longitudinal assessment of carotid intima-media thickness (IMT) changes over time in paediatric CKD patients. The results show that progressive vascular lesions occur even in children with moderate renal disease, and are in part reversible after successful renal transplantation. Consequently, extended periods of dialysis should be avoided and kidney transplantation performed as soon as possible in paediatric CKD patients.
See article by Litwin et al., pages 2552–2557
Adiponectin (ADPN) levels are consistently elevated among patients with advanced CKD, but their relationship with cardiovascular outcomes in this population remains controversial. A study in haemodialysis patients recruited to the Haemodialysis (HEMO) Study from two Boston centres found that low plasma levels of ADPN were associated with inflammation and pre-existing cardiovascular disease; ADPN levels predicted cardiovascular and mortality outcomes, the relationship being extensively confounded by multiple patient-related factors.
See article by Rao et al., pages 2619–2628
An expanding literature base has shown the negative impact of depression upon patients with chronic illness, including patients on dialysis. The lack of routine depression screening among the haemodialysis (HD) population may contribute to depression being under-recognised. The results of this study using the Beck Depression Inventory-II (BDI) indicate that the procedure of on-dialysis assessment using the BDI is a viable screening procedure.
See article by Chilcot et al., pages 2653–2659
Blood oxygen level-dependent MRI (BOLD MRI) can be used to assess intra-renal oxygen bioavailability by measuring the R2* level, which reflects tissue deoxyhaemoglobin levels. This paper found that the mean CR2* level was significantly higher in acute tubular necrosis (ATN) compared to the normal group and acute rejection (AR) group within 6 months of kidney transplantation. BOLD MRI could thus be a valuable method to discriminate between AR and ATN by measuring tissue oxygen bioavailability in early kidney allograft dysfunction.
See article by Han et al., pages 2666–2672
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