Advances in the last year

    The details are taken from the Nature Reviews Nephrology-review of the landmark studies in the last year which played a role in improving the understanding of renal diseases. I am only giving the summary of the review...I have made a ppt of the article and uploaded the link in the "Academia" section.

1. Glomerular diseases in 2011:

• Identification of Bovine Serum Antigen as an important antigen in the pathogenesis of Membranous Nephropathy.
• Soluble urokinase-type Plasminogen Activator Receptor (suPAR) as the probable circulating factor in the pathogenesis og FSGS.
• mTOR pathway involvement in the pathogenesis of Diabetic Nephropathy.

2. Polycystic disease in 2011:

• Demonstration of the interaction between various responsible genes.
• Macrophage as an important factor in cystogenesis.
• Newer therapeutic modalities: tolvaptan, metformin, curcumin, pyrimethamine, PPAR gamma agonists.

3. Transplantation in 2011:

• 3 yr follow up of the BENEFIT trial which showed similar benefits with Belatacept making it a possible alternative to the traditional CNI based immunosuppression.
• Desensitization protocols validated in a well controlled trial.
• Longer CIT shown to have not much bearing on the overall graft function despite higher DGF.

4. Dialysis in 2011:

• Inflammation catalyses the poor cardiovascular outcomes of other uremic factors like ADMAs.
• IL-1 antagonist anakinra given in a pilot study found to be well tolerated and significantly lowered inflammatory markers.
• Statin benefit showed in the SHARP trial which is incidentally the largest RCT in Nephrology till date.
• Atrial Fibrillation is common in dialysis patients and doubles the mortality risk. Warfarin should not be given as the anticoagulant in this population as it doubles the rate of hemorrhagic stroke.

5. AKI in 2011:

• uNGAL was shown to prognosticate poor outcomes after AKI and that it did not rise in patients with pre-renal AKI.
• urine output still remains one of the important "biomarkers" for AKI.
• newer biomarkers like mRNAs.