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[Nephrology : What's new in 2016 ?]
Valérie Jotterand Drepper1, Belen Ponte1, Karine Hadaya1
1Service de néphrologie, Département des spécialités médicales, HUG, 1211 Genève 14.
Revue Medicale Suisse
|July 14, 2017
Summary
A new treatment slowing polycystic kidney disease is available. Immunosuppression is not beneficial for IgA nephropathy, but rituximab is effective for membranous nephropathy. Renal replacement therapy timing remains debated.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Polycystic kidney disease (PKD) now has a treatment to slow its progression.
- The role of immunosuppression in IgA nephropathy and membranous nephropathy requires clarification.
- Optimal timing for renal replacement therapy in acute kidney injury (AKI) is under ongoing discussion.
- Advances in renal replacement therapy and transplantation offer new options for end-stage renal failure.
Purpose of the Study:
- To review current therapeutic strategies and ongoing debates in nephrology.
- To highlight recent advancements in treating specific kidney diseases.
- To discuss the evolving landscape of renal replacement therapy and kidney transplantation.
Main Methods:
- Literature review of recent findings in nephrology.
- Analysis of treatment efficacy for various kidney conditions.
- Discussion of clinical decision-making in renal replacement therapy and transplantation.
Main Results:
- A novel treatment for slowing polycystic kidney disease is now available in Switzerland.
- Immunosuppression offers no benefit in treating IgA nephropathy.
- Rituximab demonstrates efficacy in treating membranous nephropathy.
- The optimal initiation of renal replacement therapy for acute kidney injury remains a subject of debate.
- Twice-weekly hemodialysis is a viable option for selected end-stage renal failure patients.
- Peritoneal dialysis is suitable for frail patients.
- Transplantation with a HLA-incompatible living donor is preferable to waiting list.
- Calcineurin inhibitor-free immunosuppression poses immunologic risks.
- Belatacept-based immunosuppression shows improved long-term graft and patient survival over cyclosporin, despite increased acute rejection.
Conclusions:
- New therapeutic avenues are emerging for kidney diseases like PKD.
- Treatment strategies for IgA and membranous nephropathy are becoming more defined.
- Renal replacement therapy and transplantation decisions require individualized approaches.
- Immunosuppression protocols in transplantation continue to evolve, balancing efficacy and risks.
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