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Nephron NEWS

Issue 9  [December 2009]

I take the opportunity of the December issue of Nephron Digest to send all the readers of Nephron Digest the warmest seasonal greetings and wish you a Happy New Year.



Professor Meguid El Nahas, PhD, FRCP
Editor, Nephron Clinical Practice
nephron@sheffield.ac.uk
m.el-nahas@sheffield.ac.uk


Digest of issue 113/4/2009

Locatelli and colleagues (Nephron Clin Pract 2009;113:c286-c293) provide a critical appraisal of the literature on the use of inhibitors of the RAAS system in CKD. They warn against misuse of these agents, either alone or in combination, in the elderly and those with ischaemic nephropathies. This coincides with a recent publication showing that stopping inhibitors of the RAAS system in patients with CKD5 can be beneficial, with reversal of previously relentless renal functional decline and delaying onset of ESRD (Ahmed et al, Nephrol Dial Transplant 2009 Oct 10).

Thuraisingham and Yaqoob (Nephron Clin Pract 2009;113:c294-c300) examine the evidence upon which guidelines for the management of hypertension in CKD are based. They also take a critical look at the use of ACE inhibitors/ARBs in CKD, highlighting sudden or progressive deterioration of kidney function in some patients treated with these agents. On the other hand, they report a favourable response when RAAS inhibitors were discontinued and go on to stress that treatment decisions should primarily rely on efficacy of BP lowering, tolerability and cost-benefit ratio. They caution against uncritical and indiscriminate applications of guidelines, reminding the reader that most of the current guidelines are based on expert opinion and little supporting evidence.

Vij et al. (Nephron Clin Pract 2009;113:c281-c285) conclude that urine culture should be requested to confirm UTIs in dialysis patients. Alternate tests such as pyuria (low specificity), urinary nitrites levels (very poor sensitivity) are much less reliable.

Yoon and colleagues (Nephron Clin Pract 2009;113:c241-c249) report the outcomes of renal allografts coming from spousal, emotionally related donors compared to living unrelated donors (LUDs). Spousal donor kidneys compare favourably, showing a similar outcome to kidneys taken from better HLA-matched and younger LUDs. It is important to caution against LUDs as the Istanbul declaration of 2008 takes a very strong stand against LUDs, they often being the victims of organ trafficking and abuse (Am J Transplant 2009;9:2466-2469).