TY - JOUR
AB - Although intuitively many nephrologists would believe that strict glycaemic control in diabetic patients with ESRD should be beneficial, a lucid editorial comment in this issue tells us that it is not that simple. Although there is a lot of evidence that strict glycaemic control can reduce the risk of nephropathy in diabetics with normal renal function and/or mild CKD, recent studies describe that antidiabetic treatment in patients with advanced stages of CKD may even increase mortality. See editorial comment by Schernthaner et al., pages 2044–2047 Several vaccination schemes, including administration of extra high doses, have been proposed to increase the response to hepatitis B virus vaccination in CKD patients. However, a recent multicentre, randomized, controlled trial found no evidence of a worthwhile clinical benefit from increasing the three-dose intramuscular Engerix-B vaccine from a 40- to 80-µg dose. An accompanying editorial comment describes several strategies that contribute to the reduction of the transmission of HBV in dialysis patients. See original article by Chow et al., pages 2303–2310 and editorial comment by Labrioli and Jadoul, pages 2047–2049 One of the proposed advantages of more biocompatible peritoneal dialysis (PD) solutions containing low levels of glucose degradation products (GDPs) is a longer preservation of the residual renal function (RRF). In this issue, a multicentre, prospective, randomized, controlled, open trial demonstrates a significant benefit concerning preservation of RRF and urine volume by using PD fluid with low GDP levels. A critical accompanying editorial comment challenges, however, the conclusions of this study. See original article by Haag-Weber et al., pages 2288–2297 and editorial comment by Bargman, pages 2050–2051 AST-120 is a well-known oral adsorbent which binds and prevents absorption of several biologically active substances such as indole from the gastrointestinal tract. Indole is a precursor of indoxyl sulphate, a well-known uraemic substance. AST-120 treatment significantly reduced albuminuria in diabetic rats, and the significantly increased expression of glomerular eNOS, gp91phox, p47phox and fibronection expression observed in diabetic rats was significantly abrogated by the treatment. This was associated with the amelioration of enhanced oxidative stress. See original article by Lee et al., pages 2134–2141 The International Study Group of Fabry Nephropathy has developed a standardized scoring system of both Fabry disease-specific lesions, i.e. lipid deposition related and general lesions of progression, i.e. fibrosis and sclerosis. This scoring system showed a spectrum of histologic appearances even in the early clinical stage of Fabry nephropathy and supports the role of kidney biopsy in the baseline evaluation of Fabry nephropathy, even with mild clinical disease. See original article by Fogo et al., pages 2168–2177 Atypical HUS (aHUS) is thought to be caused by predisposing mutations in genes encoding different complement (regulating) proteins. The clinical impact of this knowledge is high, as it might be a prognostic factor for the outcome of renal transplantations and kidney donations. The genetic abnormalities complement factor H (CFH), complement factor I (IF) and membrane cofactor protein (MCP/CD46) are three important regulatory proteins of the alternative pathway. Very recently, the presence of autoantibodies against CFH (αFH), in combination with a homozygous polymorphic deletion of complement factor H-related genes CFHR1 and CFHR3(ΔCFHR1/3) as well as other mutations, has been associated with aHUS. Genetic abnormalities or the presence of αFH were detected in 31.9% of 72 Dutch and Belgian patients diagnosed with aHUS. Furthermore, bigenic mutations were present, indicating that routine DNA mutation analysis of all complement factors associated with aHus is important. See original article by Westra et al., pages 2195–2202 Little is known about the incidence and outcomes of acute kdney injury (AKI) occurring in patients with stable chronic kidney disease (CKD). In a large referred cohort of CKD patients followed up by nephrologists, 44.9% had at least one AKI episode. It appears that the incidence of AKI is less with older age in this population, but AKI was associated with both a higher risk of death and an increased risk of dialysis. See original article by Lafrance et al., pages 2203–2209 In patients with chronic kidney disease (CKD), the circulating monocyte cell fraction expressing high levels of CD14 and CD16 is expanded and the numbers of these cells are predictive for cardiovascular disease. A preliminary clinical study describes how a combined biomarker consisting of high numbers of CD14++CD16+ cells together with high expression of angiotensin-converting enzyme (ACE) on these cells could be useful for predicitng, in particular, cardiovascular mortality in dialysis patients. See original article by Ulrich et al., pages 2265–2272 Glutathione (GSH) acts as a free radical scavenger that may be helpful in preventing reperfusion injury, and N-acetylcysteine (NAC) replenishes the GSH stores. A randomized, double-blind, placebo-controlled trial of 100 patients undergoing orthotopic liver transplantation (OLT) evaluated the efficacy of NAC in improving liver graft performance and reducing the incidence of post-operative acute kidney injury (AKI). Both groups were followed up for 1 year post-orthotopic liver transplant (OLT). Despite the fact that higher doses of NAC were used than in most previous renal protection studies, GSH levels were highly variable with only 50% of patients receiving NAC exhibiting increased levels. Overall, NAC did not affect survival, graft function or risk of AKI. See original article by Hilmi et al., pages 2328–2333 © The Author 2010. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org Oxford University Press
TI - In this issue…
JF - Nephrology Dialysis Transplantation
DO - 10.1093/ndt/gfq349
DA - 2010-07-01
UR - https://www.deepdyve.com/lp/oxford-university-press/in-this-issue-nRdIK93Oc3
SP - i
EP - ii
VL - 25
IS - 7
DP - DeepDyve
ER -