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[Nephrology : What's new in 2016 ?]

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  • 1Service de néphrologie, Département des spécialités médicales, HUG, 1211 Genève 14.

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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.

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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.