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This Month's Highlights

	BASIC RESEARCH

Top BASIC RESEARCH CLINICAL EPIDEMIOLOGY CLINICAL RESEARCH

T-bet Promotes Renal Injury in Crescentic GN

Crescentic glomerulonephritis is driven by an immune response consisting predominantly of the Th1 subset of helper T cells. T-bet is a transcription factor that plays a role in committing CD4⁺ T cells to the Th1 lineage. Phoon et al. report that, upon induction of glomerulonephritis in mice, T-bet^–/– mice develop fewer glomerular crescents, less proteinuria, and less tubulointerstitial inflammation than wild-type mice. They observed decreased intrarenal levels of chemoattractants of Th1 cells and reduced Th1 systemic immunity. These results suggest that T-bet may promote renal injury in crescentic glomerulonephritis by altering the Th1/Th2 balance of the immune response. See Phoon et al., pages 477–485.

Podocytes Form Glomerular Crescents

Do human glomerular crescents contain podocytes? This has been a difficult question to answer, because injured podocytes lose their differentiation markers, making their identification challenging. Thorner et al. hypothesized that nestin, an intermediate filament protein that is detected in both normal and diseased podocytes, could be used to determine whether podocytes participate in the formation of crescents. The authors studied 35 human biopsies showing crescentic glomerulonephritis and found that all crescents contained nestin-positive cells, and many of these cells were proliferating. Two mouse models of glomerulonephritis support their conclusion that podocytes play a role in the formation of glomerular crescents. See Thorner et al., pages 495–502.

	CLINICAL EPIDEMIOLOGY

Top BASIC RESEARCH CLINICAL EPIDEMIOLOGY CLINICAL RESEARCH

 
Intensive Insulin Therapy Benefits Kidneys in Critically Ill

Two large, randomized, controlled trials have shown that intensive insulin therapy benefits the kidney function of critically ill patients. Schetz et al. combined the data from 2707 patients in these trials and performed a secondary analysis of the renoprotective effects of insulin. The benefits of intensive insulin therapy are most pronounced in surgical patients, for whom it reduces the risk for a composite acute kidney injury end point as well as for individual end points of oliguria and need for renal replacement therapy. Patients in the medical intensive care unit experience less benefit, but their greater severity of illness on admission may explain this difference. See Schetz et al., pages 571–578.

Coronary Artery Calcification in Mild to Moderate CKD

Among people with ESRD, coronary artery calcification is extremely common. It is unknown, however, whether less severe kidney dysfunction is also associated with increased vascular calcification. Ix et al. evaluated 6749 middle-aged participants without cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis. Their unadjusted analysis suggests an association of kidney dysfunction and coronary artery calcification, but this association is completely lost after adjustment for age, gender, race, hypertension, and IL-6 levels. These results suggest that accelerated coronary artery calcification is unlikely to explain the increased cardiovascular risk among those with mild to moderate kidney dysfunction. See Ix et al., pages 579–585.

	CLINICAL RESEARCH

Top BASIC RESEARCH CLINICAL EPIDEMIOLOGY CLINICAL RESEARCH

 
CHGA Variants Associate with Hypertensive ESRD

Chromogranin A, released from vesicles of neuronal cells along with catecholamines, plays a role in determining sympathetic tone. Salem et al. performed two independent case-control studies to investigate variants in the chromogranin A gene (CHGA) among black individuals. The authors report that two specific CHGA haplotypes were significantly more common in those with hypertensive ESRD than in disease-free control subjects, and they explore the possible functional relevance of these variants. Their findings are consistent with the hypothesis that altered sympathetic tone contributes to the pathogenesis of hypertensive nephrosclerosis in black individuals. See Salem et al., pages 600–614.

Related Articles

Tight Blood Glucose Control Is Renoprotective in Critically Ill Patients

Miet Schetz, Ilse Vanhorebeek, Pieter J. Wouters, Alexander Wilmer, and Greet Van den Berghe
J. Am. Soc. Nephrol. 2008 19: 571-578. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles