The high mobility group box chromosomal protein 1 (HMGB1), a nuclear DNA-binding protein, has recently been recognized as a new proinflammatory cytokine. The purpose of this study was to examine the significance of HMGB1 in patients with renal diseases. It concluded that HMGB1 was expressed in the sera of patients with renal diseases who underwent renal biopsies, especially among those who had vasculitis including ANCA-GN, Henoch-Schönlein purpura nephritis, and IgAN with glomerular crescents.

The aim of this study was to determine whether high-molecular-weight (HMW) or total adiponectin levels are associated with arteriosclerosis in patients with IgA nephropathy. It concluded that total serum adiponectin levels are an independent determinant of arteriosclerosis in IgA nephropathy patients.

The aim of this retrospective study was to analyze the demographic, clinical, laboratory features, and the treatment modalities of patients with vasculitis who had renal involvement. This is of interest to the IgAN community given that some cases of pediatric IgAN seem to be associated with the broader symptoms of Henoch-Schönlein purpura (HSP). The study concludes that in the context of renal involvement, significant improvement in the long-term survival of these patients can be achieved with the institution of early and aggressive immunosuppressive treatment.

The association of HSP with methicillin-resistant staphylococcus aureus has frequently been reported in the literature. This report presents a case of HSP in association with MSSA bacteremia from central venous catheterization for an unrelated problem. Proteinuria was markedly reduced, renal function improved, and purpura disappeared after administration of antibiotic and steroid therapy.

This report describes a rare case of Behçet’s disease complicated by nephrotic syndrome due to IgA nephropathy.

This single-centre prospective study assessed low-dose steroid therapy in the treatment of patients with IgAN, given that no accepted therapy has been established for progressive IgA nephropathy. It suggested that low-dose steroid therapy for IgAN patients with mild inflammatory lesions could reduce the amount of proteinuria and prevent deterioration of renal function in cases where a renal biopsy has shown mild vascular lesions.

The aim of this study was to examine the long-term effectiveness of prednisolone and cyclophosphamide therapy on the clinical course of IgAN. It observed eighteen patients for more than 2 years after this treatment. It concluded that long-term follow-up is essential in order to prove the long-term benefit of immunosuppressive therapy in patients with IgAN. It also suggests that careful monitoring of serum IgA level may be useful in the follow-up of patients with IgAN, especially when they are treated with immunosuppressive agents.

The objective of this Canadian study was to describe maternal and fetal outcomes in addition to the changes in biochemical parameters after conception in a cohort which included five patients (age range, 31 to 37 yr) who had seven pregnancies while on nocturnal home hemodialysis and delivered six live infants. It concluded that this form of dialysis may allow for improved fertility.

This study evaluated the safety and efficacy of tacrolimus in children with steroid-resistant nephrotic syndrome. It concluded that tacro is an effective therapeutic modality in this context, including the subgroup of children who are nonresponsive to current therapeutic modalities like cyclophosphamide and cyclosporine.

The objective of this study was to describe the experiences of parents who have children with chronic kidney disease. It concluded that being a parent of a child with chronic kidney disease demands a high-level health care provider, problem solving, information seeking, and financial and practical skills. Parents of children with chronic kidney disease need multidisciplinary care, which may lead to improved outcomes for their children. Original abstract available.

Based on structured interviews and a review of selected routine blood tests of 46 current survivors of long-term dialysis at a single centre, this study showed that despite accumulating morbidity, these patients reveal a surprisingly stable and socially well-adjusted group, with low rates of hospital admission.

Meta-analysis concludes that while statins significantly reduce lipid concentrations and cardiovascular end points in patients with chronic kidney disease, irrespective of stage of disease, no benefit on all cause mortality or the role of statins in primary prevention has been established. Renal protective effects of statins are uncertain because of relatively sparse data and possible outcomes reporting bias.

Patients who choose to be highly involved in their medical treatment actually fare less well with chronic health problems than patients who defer to their doctors, finds a new study.

Tubular atrophy, a late phenomenon in the progression of IgAN, is one of the factors which predict poor outcome. Published in the Scandinavian Journal of Urology and Nephrology, this retrospective study concludes that glomerular deposition of C5b-9 may participate in the development of glomerulosclerosis in IgAN, and that its positive correlation with the intensity of tubular agr3b.beta1-integrin suggests a possible implication in the development of tubulointerstitial fibrosis.

This article reiterates the following about IgA nephropathy:
- most frequent type of primary glomerulonephritis worldwide;
- characteristic presentation is gross hematuria at the time of an infectious episode;
- renal biopsy still is mandatory for the diagnosis.
- clinical and pathologic progression over time can vary from a few years to more than 50 years;
- 3 major independent risk factors are arterial hypertension, proteinuria more than 1 g/d, severe renal histopathologic lesions including hyalinosis, crescents;
- suggests treatment in the following order: control of hypertension, control of proteinuria when persisting for greater than 1 g/d, and evidence-based treatment where available for severe lesions.
- treatment strategy is symptomatic because pathogenesis and etiology of this disease still remain unclear.

A review article which looks at the pros and cons of renin-angiotensin system blockade in kidney transplantation.

Clinical research study provides evidence that the abnormal glycosylation of IgA1 which is characteristic of IgA nephropathy is an inherited rather than an acquired trait. It also suggests that because most relatives with abnormal IgA1 glycoforms were asymptomatic, additional cofactors must be required for IgAN to develop.

This study found that early steroid withdrawal after kidney transplant resulted in less metabolic syndrome and fewer cardiovascular events than did chronic corticosteroid therapy (CCS).

The Foundation for IgA Nephropathy has added Kidney Corner to its Links page on www.igan.ca

We highly recommended this well-moderated online support group which focuses on pediatric kidney diseases.

Report on multiple documentated cases of malformation in babies born to women on MMF for organ transplantation. It suggests that women who are taking MMF for any indication require counseling of the potential risks prior to pregnancy. Abstract available by following the link.

This review article suggests the long held belief that peritoneal dialysis (PD) is better at preserving residual renal function (RRF) than hemodialysis (HD) may no longer be true. It calls for more robust studies to determine the relative importance of RRF in HD and strategies to best preserve this vital asset.

A review about the growing evidence supporting combination treatment of nephropathies with an ACE inhibitor plus an ARB to more completely block the renin-angiotensin system and provide greater renoprotection than either an ACE inhibitor-based or ARB-based regimen. It states that while the National Kidney Foundation suggests ACE inhibitors and ARBs may be used in combination to reduce proteinuria in patients with kidney disease, larger outcomes trials are needed.

From an Image in Clinical Medicine article in the January 24, 2008 issue of the New England Journal of Medicine, an important caution about the risk of high-dose vitamin C therapy in patients with renal failure.

This randomized, open-label, multicenter study reports that its primary objective of demonstrating that steroid-free or steroid-withdrawal therapies are not inferior compared to standard steroids in terms of 12-month GFR was not met. The 12-month incidence of biopsy-proven acute rejection (BPAR) was significantly less frequent with standard steroids than either of the other two regimens. It concludes that for standard-risk renal transplant patients receiving CsA-ME, EC-MPS and basiliximab, steroid withdrawal by the end of week 1 achieves similar 1-year renal function to a standard-steroids regimen, and may be more desirable than complete steroid avoidance.

This review analyzes the literature currently available on the treatment of primary glomerulopathies with mycophenolate mofetil (Cellcept). It reports encouraging results in minimal change nephropathy, and less encouraging results in medium and high risk patients with focal segmental glomerulonephritis and idiopathic membranous nephropathy. With regard to IgA nephropathy, conflicting results have been reported in controlled trials. It concludes that randomized control trials of sufficient statistical significance remain necessary to estimate the real effectiveness of mycophenolate mofetil in primary glomerulopathies.

A systematic review of abstracts from national meetings and selected reference lists examined data which suggests that adding aldosterone blockers to ACE-inhibitor and/or ARB therapy yields significant decreases in proteinuria without adverse effects of hyperkalemia and impaired renal function. It concludes that while their findings promote interesting hypotheses for future study, routine use of these drugs as additive therapy in patients with chronic kidney disease cannot be recommended yet.

IgA nephropathy is the most common chronic kidney disease in China. A genetic variation in Megsin confers susceptibility to IgAN in Chinese people. Chinese prospective clinical trials showed that benazepril (BZ) conferred substantial renal benefits in patients with advanced renal insufficiency. Combined therapy with urokinase and BZ was more effective than with BZ alone in reducing proteinuria and protecting renal function in Chinese patients with severe IgAN.