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Nat Clin Pract Nephrol 2009 Mar;5(3):143-56

Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Tuberous sclerosis complex and von Hippel-Lindau disease are distinct autosomal dominant tumor suppressor syndromes that can exhibit similar renal phenotypes and seem to share some signaling pathway components. Similarities exist in the current clinical management of, and the newly identified potential therapeutic approaches for, these conditions. This Review summarizes the pathophysiologic and therapeutic overlap between tuberous sclerosis complex and von Hippel-Lindau disease and highlights the results of recent drug trials in these settings. Read More

Nat Clin Pract Nephrol 2009 Mar;5(3):117

Nat Clin Pract Nephrol 2009 Mar;5(3):E2; discussion E3

Hua Chiew Hospital, Bangkok 10100, Thailand.

Nat Clin Pract Nephrol 2009 Mar;5(3):E1

TMS BioScience/Therapeutic Monitoring Services, 134 LaSalle Street, Lab 4, New Orleans, LA 70112, USA.

Nat Clin Pract Nephrol 2009 Mar 3;5(3):157-70. Epub 2009 Feb 3.

Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.

Skin disorders associated with chronic kidney disease (CKD) can markedly affect a patient's quality of life and can negatively impact their mental and physical health. Uremic pruritus, which is frequently encountered in patients with CKD, is considered to be an inflammatory systemic disease rather than a local skin disorder. Biomarkers of inflammation are increased in patients with uremic pruritus and an imbalance of the endogenous opioidergic system might be involved in the complex pathogenesis of the disease. Read More

Nat Clin Pract Nephrol 2009 Feb;5(2):59

Nat Clin Pract Nephrol 2009 Feb;5(2):E1

Northern Ontario School of Medicine, Clinical Sciences Division, Timmins & District Hospital, 640 Ross Avenue East, Suite E, Timmins, ON P4N 8P2, Canada.

Nat Clin Pract Nephrol 2009 Mar 27;5(3):172-6. Epub 2009 Jan 27.

Division of Cardiology, University of Colorado Health Sciences Center, Denver, CO 80220, USA.

Background: A 31-year-old woman with tuberous sclerosis complex presented with a 1 week history of subjective fever, chills, rigors, poor appetite and dizziness.

Investigations: Physical examination, urine and blood analysis, CT of the abdomen, chest and brain, and chest X-ray.

Diagnosis: End-stage renal disease, septic shock and urinary tract infection secondary to huge bilateral angiomyolipomas of the kidney associated with tuberous sclerosis complex. Read More

Nat Clin Pract Nephrol 2009 Mar 27;5(3):132-42. Epub 2009 Jan 27.

Columbia University Medical Center, New York, NY 10032, USA.

Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive medication in transplantation for over a decade. Owing to its efficacy and relatively benign adverse effect profile, its use has been investigated in the treatment of several glomerular diseases, as we describe in this Review. Of these, MMF has most extensively been studied in lupus nephritis. Read More

Nat Clin Pract Nephrol 2009 Mar 27;5(3):122-3. Epub 2009 Jan 27.

Division of Nephrology at Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium.

This commentary discusses a study reported by Kumar et al. that compared outcomes of 56 patients with autosomal dominant polycystic kidney disease (ADPKD) started on peritoneal dialysis with those of a control group of nondiabetic patients matched for age, sex and year of starting peritoneal dialysis. During follow-up (mean 37 months), patient survival, technique survival and peritonitis rates were similar in the two groups. Read More

Nat Clin Pract Nephrol 2009 Mar 27;5(3):124-5. Epub 2009 Jan 27.

Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

Cardiac troponin T (cTnT) levels are often elevated in chronic kidney disease and correlate with survival of patients receiving dialysis. This commentary discusses a recent paper by Hickson et al. that investigated whether a single cTnT measurement can predict survival of patients on the waiting list for renal transplantation. Read More

Nat Clin Pract Nephrol 2009 Mar 27;5(3):128-9. Epub 2009 Jan 27.

Columbia University Medical Center, New York, NY, USA.

Medical tourism is increasing owing to high costs of care, lack of availability or long waits for procedures, and improvements in technology and standards of care in many countries. Transplant tourism is one example of medical tourism that has been attracting increasing attention because of concerns over poor treatment and outcomes of both donors and recipients. Most such cases involve vended kidneys obtained from vulnerable populations, and both donors and recipients receive inferior care by US standards. Read More

Nat Clin Pract Nephrol 2009 Mar 20;5(3):126-7. Epub 2009 Jan 20.

University of Oxford, Clinical Trial Service Unit, Oxford, UK.

This article discusses the conclusions of a retrospective cohort study reported by Garg et al. on behalf of the Donor Nephrectomy Outcomes Research (DONOR) Network. This study compared the incidence of cardiovascular events in a cohort of kidney donors with that in a matched control population, to establish whether living kidney donation is associated with increased cardiovascular risk. Read More

Nat Clin Pract Nephrol 2009 Feb 23;5(2):101-11. Epub 2008 Dec 23.

University of Colorado School of Medicine and Denver VA Medical Center, Denver, CO, USA.

The rapid rise in the incidence and prevalence of obesity and the concomitant increase in the incidence and prevalence of hypertension have fueled investigation into the role of obesity in the pathogenesis of hypertension. The genetic background that predisposes obese individuals to hypertension is being elucidated, and the importance of adipose tissue as an endocrine organ in the pathogenesis of hypertension is increasingly being recognized. Visceral adipose tissue is critical in the production of pathologic cytokines that are thought to mediate obesity-induced hypertension. Read More

Nat Clin Pract Nephrol 2009 Mar 23;5(3):130-1. Epub 2008 Dec 23.

Nephrology Section, University Hospital of Ghent, Ghent, Belgium.

Nat Clin Pract Nephrol 2009 Jan;5(1)

Nat Clin Pract Nephrol 2009 Feb 17;5(2):112-6. Epub 2008 Dec 17.

David Geffen School of Medicine at UCLA, Interventional Nephrology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.

Background: A 43-year-old African-American female (gravida 5 para 0) with an 8-week intrauterine pregnancy presented to the emergency room with crampy abdominal pain, shortness of breath, and shoulder pain. She had normal renal function on admission. CT angiography of the chest revealed bilateral pulmonary emboli; therefore, the AngioJet (Possis Medical, Inc. Read More

Nat Clin Pract Nephrol 2009 Feb 17;5(2):68-9. Epub 2008 Dec 17.

Medizinische Poliklinik, University of Munich, Munich, Germany.

Biomarkers that reliably identify or even predict disease manifestations in systemic lupus erythematosus (SLE) are needed. In a recent issue of the Clinical Journal of the American Society of Nephrology, Wu and colleagues reported on the predictive value of routine D-dimer measurements for future thromboembolic events in patients enrolled in the Ohio SLE study, a unique prospective, longitudinal evaluation of individuals with recurrently active SLE. As in other disease settings, low D-dimer levels (<0. Read More

Nat Clin Pract Nephrol 2009 Feb 9;5(2):89-100. Epub 2008 Dec 9.

Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, USA.

Evidence suggests that virtually every organ system in the human body possesses a local renin-angiotensin system (RAS). These local systems seem to be independently regulated and compartmentalized from the plasma circulation, perhaps with the exception of the vascular endothelial system, which is responsible for maintaining physiological plasma levels of RAS components. Among these local RASs, the kidney RAS--the focus of this Review--seems to be of critical importance for the regulation of blood pressure and salt balance. Read More

Nat Clin Pract Nephrol 2009 Feb 9;5(2):64-5. Epub 2008 Dec 9.

Division of Nephrology and Kidney Center, Kobe University School of Medicine, Kobe, Japan.

Acute kidney injury (AKI), mainly as a result of crush syndrome, is the second most common cause of death in large earthquakes. It is well known that AKI is preventable with early management (particularly with fluid therapy), but a means of determining which patients are at risk is needed. This Practice Point commentary discusses Najafi et al. Read More

Nat Clin Pract Nephrol 2009 Feb 9;5(2):70-1. Epub 2008 Dec 9.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

This Practice Point commentary discusses the findings and limitations of a report by Gritsch et al., in which the authors concluded that human leukocyte antigen (HLA)-DR-mismatched kidneys from deceased donors aged 35 years or less are suitable for use in pediatric patients. We highlight the issues to be considered before adopting such an allocation policy. Read More

Nat Clin Pract Nephrol 2009 Feb 9;5(2):66-7. Epub 2008 Dec 9.

Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.

Serum ferritin level, the most commonly used marker for determining iron status in patients with chronic kidney disease, is influenced by factors such as inflammation and malnutrition. Moreover, there seems to be considerable biological variability and analytical variation between different serum ferritin assays. This Practice Point commentary discusses a recent paper by Ford et al. Read More

Nat Clin Pract Nephrol 2008 Dec;4(12):643

Nat Clin Pract Nephrol 2009 Feb 2;5(2):76-7. Epub 2008 Dec 2.

Renal Medicine Department, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.

Nat Clin Pract Nephrol 2009 Feb 2;5(2):78-88. Epub 2008 Dec 2.

University of Kansas Medical Center, Department of Pediatrics, Division of Nephrology, Kansas City, KS 66160-7330, USA.

The renal features of sickle cell disease (SCD) include some of the most common reasons for referral to nephrologists, such as hematuria, proteinuria, tubular disturbances and chronic kidney disease. Therapy of these conditions requires specialized knowledge of their distinct pathogenic mechanisms. Painless hematuria is usually benign--unless massive--and can be treated with hydration alone if renal medullary carcinoma has been ruled out. Read More

Nat Clin Pract Nephrol 2009 Jan 25;5(1):34-44. Epub 2008 Nov 25.

Centre de Rein Artificiel, Tassin, France.

The duration and frequency of hemodialysis was determined empirically when this therapy first came into use, and treatment was commonly three 8 h sessions per week by the end of the 1960s. Subsequently, however, the growing number of patients who required this therapy had to be reconciled with the shortage of equipment; therefore, dialysis time was decreased to three 4 h sessions per week. At the same time, on the basis of data from the first randomized controlled trial of dialysis -- the National Cooperative Dialysis Study -- Kt/V(urea) was devised as the optimum measure of dialysis adequacy. Read More

Nat Clin Pract Nephrol 2009 Jan 25;5(1):54-8. Epub 2008 Nov 25.

Department of Nephrology, John Hunter Hospital, New Lambton Heights, NSW, Australia.

Background: A 42-year-old previously healthy man was referred to hospital with an 8-week history of fevers, night sweats, fatigue, and unintentional weight loss. There was no past history of medical illness or any medication use. Physical examination was unremarkable. Read More

Nat Clin Pract Nephrol 2009 Jan 25;5(1):46-53. Epub 2008 Nov 25.

University of Pennsylvania, Philadelphia, PA 19104, USA.

Vaccine-preventable diseases are a major cause of morbidity and mortality in renal transplant candidates and recipients. Assessing the need for and providing appropriate vaccinations can greatly reduce the infectious complications associated with solid organ transplantation. This Review outlines the basic tenets of vaccination in solid organ transplant candidates and recipients and summarizes the available literature on the efficacy and safety of the most relevant vaccines for patients who are scheduled for or who have undergone renal transplantation. Read More

Nat Clin Pract Nephrol 2009 Feb 25;5(2):74-5. Epub 2008 Nov 25.

Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7155, USA.

Nat Clin Pract Nephrol 2009 Jan 18;5(1):22-3. Epub 2008 Nov 18.

Division of Nephrology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.

Nat Clin Pract Nephrol 2009 Jan 18;5(1):6-7. Epub 2008 Nov 18.

Montefiore Medical Center, Department of Medicine, Bronx, NY 10467, USA.

This Practice Point commentary discusses a study by Ahmed et al. that evaluated the effects of hormone replacement therapy (conjugated estrogen alone, progestin alone or a combination of progestin and conjugated estrogen) on renal function in elderly community-dwelling postmenopausal women. The authors found that oral estrogen therapy in this population was associated with accelerated decline in kidney function over a 2-year period. Read More

Nat Clin Pract Nephrol 2009 Feb 18;5(2):72-3. Epub 2008 Nov 18.

University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.

This Practice Point commentary reviews a study by Sberro et al. that evaluated formulae to predict the lowest measured serum creatinine concentration in kidney transplant recipients following surgery. The objective of the study was to ascertain a simple means of identifying patients with inappropriately high serum creatinine concentrations, who are in need of further investigation. Read More

Nat Clin Pract Nephrol 2009 Jan 11;5(1):18-9. Epub 2008 Nov 11.

Home Dialysis Program, University of Wisconsin Madison Medical School, Madison, WI, USA.

Although renal transplantation confers a survival advantage over maintenance dialysis in patients with end-stage renal disease, many factors can attenuate this survival advantage over the long term. Among the most important negative influences on outcomes are older donor age, extended time on the transplant waiting list, and use of organs from deceased donors. Whether it is better to avoid prolonged waiting times for a standard criteria donor kidney by transplanting an organ from an older living donor is a clinically important question. Read More

Nat Clin Pract Nephrol 2009 Jan 11;5(1):10-1. Epub 2008 Nov 11.

Department of Medicine, University of California San Diego, San Diego, CA 92103, USA.

This Practice Point commentary discusses the findings from the secondary analysis of a large systematic cohort study of critically ill patients that evaluated the influence of fluid overload on outcomes from acute kidney injury (AKI). Payen et al. reported a 36% incidence of AKI among the 3,147 patients enrolled in the Sepsis Occurrence in Acutely Ill Patients (SOAP) study. Read More

Nat Clin Pract Nephrol 2009 Jan 11;5(1):8-9. Epub 2008 Nov 11.

Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

This Practice Point commentary discusses a recent paper in which Vikse et al. demonstrated that history of preeclampsia is a marker for an increased risk of end-stage renal disease (ESRD). Among women with preeclampsia, giving birth to a low-birth-weight or preterm infant further increased the relative risk of ESRD, which suggests that more-severe preeclampsia might be a marker for an even higher risk of ESRD. Read More

Nat Clin Pract Nephrol 2009 Jan 11;5(1):16-7. Epub 2008 Nov 11.

University of Colorado, Health Sciences Center, Division of Renal Diseases and Hypertension, Denver, CO 80262, USA.

This Practice Point commentary discusses the findings and limitations of a cohort study reported by Wald and colleagues of mineral metabolism in patients on hemodialysis. The investigators' observational analysis utilized data from the 1,846 patients in the randomized, controlled Hemodialysis (HEMO) Study. Wald et al. Read More

Nat Clin Pract Nephrol 2009 Jan 11;5(1):14-5. Epub 2008 Nov 11.

Kidney Disease Program, University of Louisville, Louisville, KY 40202-1718, USA.

This commentary discusses a small multicenter, prospective clinical trial in which patients with end-stage renal disease were randomized to treatment with online high-flux hemofiltration or low-flux hemodialysis. Over a 3-year follow-up period, survival was significantly better in patients who received online hemofiltration than in patients who received low-flux hemodialysis. In addition, the average duration, but not the frequency, of hospitalization, and the incidence of intradialytic hypotension, were lower in the hemofiltration group than in the hemodialysis group. Read More

Nat Clin Pract Nephrol 2009 Jan 4;5(1):12-3. Epub 2008 Nov 4.

University of Miami Miller School of Medicine, Nephrology Section, Veterans Affairs Medical Center, Miami, FL 33125, USA.

This commentary discusses the findings and profound clinical implications of a prespecified analysis of renal outcomes performed by Mann et al. in the large ONTARGET study. This study assessed the effects of the angiotensin-converting-enzyme (ACE) inhibitor ramipril and the angiotensin receptor blocker (ARB) telmisartan, separately and in combination, in patients aged at least 55 years who had established vascular disease or diabetes with organ damage. Read More

Nat Clin Pract Nephrol 2009 Jan 28;5(1):24-33. Epub 2008 Oct 28.

Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS 66160, USA.

Considerable advances have been made in the understanding of the pathogenesis and treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD). These include the discovery that the calcium-sensing receptor has an important role in the regulation of parathyroid gland function, the development of calcimimetics to target this receptor, the recognition that vitamin D receptor activation has important functions beyond the regulation of mineral metabolism, the identification of the phosphaturic factor fibroblast growth factor 23 and the contribution of this hormone to disordered phosphate and vitamin D metabolism in CKD. However, despite the availability of calcimimetics, phosphate binders, and vitamin D analogs, control of SHPT remains suboptimal in many patients with advanced kidney disease. Read More

Nat Clin Pract Nephrol 2008 Nov;4(11):583

Nat Clin Pract Nephrol 2008 Dec 21;4(12):682-92. Epub 2008 Oct 21.

Department of Specific Organ Regulation (Urology), Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

Given the severe shortage of deceased-donor organs in Japan, the use of living-donor kidney transplantation (LKT) strategies, such as ABO-incompatible living-donor kidney transplantation, has expanded rapidly. ABO-incompatible LKT was initially performed following splenectomy and antibody removal; however, immunosuppressive protocols for ABO-incompatible LKT have changed markedly over recent years in Japan. Mycophenolate mofetil, calcineurin inhibitors and corticosteroids are now used to achieve desensitization before transplantation, and thereby suppress acute antibody-mediated rejection. Read More

Nat Clin Pract Nephrol 2008 Dec 14;4(12):658-9. Epub 2008 Oct 14.

Histocompatibility and Molecular Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine at Emory University, Atlanta, GA 30322, USA.

This commentary discusses the strengths and weaknesses of a recent study reported by Kobayashi and colleagues, in which paired serum samples from 297 renal transplant recipients who underwent transplantation between December 1972 and September 2004 were tested for the presence of human leukocyte antigen (HLA) antibody at two discrete time points following surgery (2004 and 2006). Urine samples collected on the same day as the serum samples, were also measured for urinary protein levels. The results of the study suggest that patients with a positive change in HLA antibody status in the post-transplantation period (i. Read More

Nat Clin Pract Nephrol 2008 Dec 14;4(12):650-1. Epub 2008 Oct 14.

Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.

This Practice Point commentary discusses a recent study by Forman et al. that examined the association between baseline urinary albumin:creatinine ratio and the risk of developing hypertension among 2,179 women in the first and second Nurses' Health Studies who did not have hypertension or diabetes at baseline and had normoalbuminuria by conventional definitions. The study showed that quartiles of albuminuria beyond the lowest quartile were increasingly predictive of subsequent hypertensive disease, even at levels well below what is conventionally considered to be the normal range. Read More

Nat Clin Pract Nephrol 2008 Dec 7;4(12):693-7. Epub 2008 Oct 7.

Hospital for Sick Children, Toronto, ON, Canada.

Background: A 12-year-old boy presented to hospital with a 6-month history of crampy pre-defecation abdominal pain, non-bloody diarrhea, anorexia and weight loss. Investigations revealed hypochromic microcytic anemia, a low serum iron level, a low serum ferritin level and an elevated serum creatinine level. Histopathological examination of tissue specimens obtained at esophagogastroduodenoscopy and colonoscopy revealed features of Crohn's disease, and a renal biopsy demonstrated tubulointerstitial nephritis. Read More

Nat Clin Pract Nephrol 2008 Dec 7;4(12):656-7. Epub 2008 Oct 7.

Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria.

This Practice Point commentary discusses the findings and limitations of a randomized, double-blind study conducted by Parving and colleagues. The study evaluated the renoprotective effects of dual blockade of the renin-angiotensin-aldosterone system by adding aliskiren (an oral, direct renin inhibitor) or placebo to treatment with 100 mg daily losartan in patients who had hypertension and type 2 diabetes with nephropathy. Addition of daily aliskiren for 6 months (150 mg/day for 3 months and 300 mg/day for 3 months) reduced the mean urinary albumin:creatinine ratio by 20% (P <0. Read More

Nat Clin Pract Nephrol 2008 Dec 7;4(12):654-5. Epub 2008 Oct 7.

Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.

This Practice Point commentary discusses the implementation of an intensive, multifactorial intervention in patients who had proteinuria >3 g/day despite treatment with angiotensin-converting-enzyme inhibitors. In their 'Remission Clinic' in Bergamo, Italy, Ruggenenti et al. implemented an individual titration regimen using ramipril 5-10 mg/day, losartan 50-100 mg/day, verapamil 80-120 mg/day and atorvastatin 10-20 mg/day in successive steps, aiming for a low blood pressure target of <120/80 mmHg and a proteinuria target of <0. Read More

Nat Clin Pract Nephrol 2008 Dec 7;4(12):664-71. Epub 2008 Oct 7.

Division of Nephrology and Immunology, University of Alberta, Edmonton, AB, Canada.

The use of traditional medicine is common worldwide, with rates of use of over 80% in some populations. Considering the large number of people using traditional remedies throughout the world, it does seem that most do so without major adverse effects. Nevertheless, many folk medicines can cause kidney injury. Read More

Nat Clin Pract Nephrol 2008 Dec 30;4(12):672-81. Epub 2008 Sep 30.

University of Colorado Health Sciences Center, Denver, CO, USA.

Patients with chronic kidney disease (CKD) have a reduced lifespan, and a substantial proportion of these individuals die from cardiovascular disease. Although a large percentage of patients with CKD have traditional cardiac risk factors such as diabetes, hypertension and abnormalities in cholesterol, interventions to address these factors--which have significantly decreased cardiovascular mortality in the general population--have not shown such benefit in the CKD population. In addition, the severity and extent of cardiovascular complications in patients with CKD is disproportionate to the number and severity of traditional risk factors. Read More

Nat Clin Pract Nephrol 2008 Dec 30;4(12):662-3. Epub 2008 Sep 30.

Clinical Islet Transplant Programme, University of Alberta, Edmonton, AB, Canada.

Nat Clin Pract Nephrol 2009 Jan 30;5(1):20-1. Epub 2008 Sep 30.

Duke University Medical Center, Durham, NC 27710, USA.