In this issue ...
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Screening for albuminuria |
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 Top Screening for albuminuria |
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In this paper, the use of spot urine albumin concentration and urine albumin to creatinine excretion ratio for the detection of albuminuria in an Indo-Asian population in Pakistan was explored. The overall prevalence of albuminuria (30 mg/day or greater) measured in a 24h urine collection was 11.8%. It was concluded that both the urine albumin concentration and albumin to creatinine ratio are acceptable tests for population screening for albuminuria in Indo-Asians. While sensitivities may be suboptimal, particularly in women, lowering the existing thresholds would compromise specificity.
In an accompanying editorial, the role of pre-screening followed by confirmation, the cut-off value in pre-screening and the monitoring of patients with albuminuria are elegantly discussed by Gansevoort et al., the group involved in the PREVEND study.
See articles by Jafar et al., pages 2194–2200 and Gansevoort et al., pages 2109–2111
Nephrotoxicity of cisplatin This paper investigates the effect of SP600125, a selective inhibitor of phosphorylated JNK (p-JNK), a mediator of apoptosis and thought to play a role in cisplatin nephrotoxicity. This inhibitor attenuated both the functional and structural alterations induced by cisplatin in rat kidneys.
An accompanying editorial briefly describes the mechanisms involved in cisplatin cytotoxicity, and the clinical and experimental treatments available to reduce the cisplatin nephrotoxicity.
See articles by Francescato et al., pages 2138–2148 and Razzaque, pages 2112–2116
HIV-associated renal diseases in Africa An interesting editorial by Cohen and Kimmel comments on a clinical study on the prevalence and risk factors for kidney diseases in an HIV-infected indigenous African population.
Renal insufficiency (creatinine clearance <60 ml/min) was present in 11.5% of the investigated population, while proteinuria, defined as a dipstick-positive urine equal or >1+, was found in only 6.2%.
The editorial discusses not only the impact of HAART therapy but also stresses the desperate need for additional studies on HIV-associated renal diseases.
See articles by Cohen and Kimmel, pages 2116–2119 and Wools-Kaloustian et al., pages 2208–2212
Childhood hypertension A nice editorial discusses the definition, causes and consequences of paediatric hypertension and its relevance for the adult nephrologist. This paper clearly shows that the blood pressure level attained in childhood has significant short- and long-term impacts on cardiovascular health in adults.
See article by Hadtstein and Schaefer, pages 2119–2123
Steroid-resistant childhood nephrotic syndrome (SRNS) is probably overdiagnosed and undertreated A retrospective study investigated 86 children with SRNS and found improved rates of complete remission in children with idiopathic focal segmental glomerulosclerosis and minimal change nephrotic syndrome after prolonged and intensified combination therapies using ciclosporin A (CSA) and prednisolone. See article by Ehrich et al., pages 2183–2193
White coat hypertension in chronic kidney diseases This complication is frequent in patients with CKD (GFR <60 ml/min/ 1.73m2) and is important to recognize. Its prevalence was estimated at 37% of 290 consecutive CKD patients.
It can be predicted in the absence of higher systolic clinical blood pressure as well as left ventricular hypertrophy and proteinuria. In these patients, pursuing a low blood pressure target may not be safe because of the risk of cardio-renal hypoperfusion, especially at nighttime.
See article by Minutolo et al., pages 2217–2223
More on haemoglobin targets ... The time required to reach 11 g/dl haemoglobin in incident dialysis patients was associated with an increased risk of hospitalization or death. The mean time to target haemoglobin was 1.3 months and 36% of patients required longer time. See article by Ishani et al., pages 2247–2255
Burnout in dialysis staff members ... This cross-sectional study assesses and compares burnout levels in a sample of nurses and physicians working in dialysis units in Northern Italy and investigates the relationship with quality of life. It was concluded that although not a general problem, burnout can be identified in a subgroup of dialysis nurses who may profit from early supportive measures.
See article by Klersy et al., pages 2283–2290
Sirolimus and post-kidney transplant proteinuria using expanded criteria donors and calcineurin-free de novo immunosuppressive protocols This study found that sirolimus-based compared with mycophenolate mofetil (MMF)-based treatment in kidney transplantation with advanced age donors is associated with an acceptable outcome, but with the trade-off of increasing the occurrence of proteinuria in the intention-to-treat analysis. A large subgroup of the patients in the MMF group experienced acute rejection and required conversion to calcineurin inhibitors.
See article by Diekmann et al., pages 2316–2321
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Related articles in NDT:
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