Volume 10 Issue 4, April 2014

Immunosuppressive drugs commonly used in transplantation and autoimmune diseases are unfortunately associated with increased cancer incidence. Now, a new study reports a direct relationship between the number of regulatory T cells in the blood and the risk of developing invasive skin cancer in kidney transplant recipients.

The announcement by Medtronic that the SYMPLICITY HTN-3 trial failed to meet its primary effectiveness end point calls the blood pressure lowering effects of renal denervation into question. However, its safety is proven, which raises the possibility that the procedure might have beneficial effects on the kidneys beyond blood pressure reduction.

A new study reports that 30.5% of kidney transplant recipients have an early hospital readmission (EHR; defined as within 30 days of discharge). As EHR is a strong independent risk factor for allograft loss and mortality, efforts should be made to implement and improve systems to minimize risk of EHR in these patients.

Failure to achieve blood pressure control in patients with hypertension despite the use of three or more antihypertensive drugs is becoming more frequent. Although treatment-resistant hypertension has been associated with an increased risk of cardiovascular events, new evidence indicates treatment-resistant hypertension is an important risk factor for end-stage renal disease.

Pulsatile perfusion is increasingly being used to preserve kidneys harvested from non-standard-criteria donors. Indeed, retrospective analyses have shown that machine preservation is associated with reduced rates of delayed graft function. However, well-designed prospective clinical trials are needed to evaluate its impact on organ discard, rejection, long-term graft function, and cost.

AKI is associated with an increased risk of adverse outcomes, including short-term and long-term mortality, incident CKD, accelerated progression to end-stage renal disease and reduced health-related quality of life. The incidence of the disorder is increasing rapidly worldwide. In this Review, the authors discuss the epidemiology, outcomes and economic impact of AKI in developed and developing countries.

Patients with chronic kidney disease (CKD) are known to have increased all-cause and cardiovascular mortality. Of late, it has been recognized that these patients also have increased noncardiovascular mortality. Here, the authors discuss both cardiovascular and nonocardiovascular mortality in CKD, provide examples of traditional cardiovascular risk factors that also seem to be associated with noncardiovascular mortality, and summarize the potential pathophysiological mechanisms involved.

In this Review, Lo et al. discuss biomarkers of rejection in kidney transplantation, study design and the statistical analyses for biomarker validation. They also provide an overview of potential biomarkers in a variety of substrates that could serve as surrogate end points in clinical trials and aid physicians in clinical decision-making.

The notion that chronic kidney disease (CKD) can be repaired has spurred intense research over the past decade and has focused on antifibrotic therapies, with numerous strategies being explored preclinically and clinically. In this Review, the authors describe the therapeutic concepts and molecular targets under investigation to inhibit or even reverse CKD.