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Autosomal dominant polycystic kidney disease (ADPKD) is the most common potentially life-threatening monogenic disorder in humans, characterized by progressive development and expansion of fluid-filled cysts in the kidneys and other organs. Ongoing cyst growth leads to progressive kidney enlargement, whereas kidney function remains stable for decades as a result of hyperfiltration and compensation by unaffected nephrons. Kidney function irreversibly declines only in the late stages of the disease, when most of the parenchyma is lost to cystic and fibrotic tissue and the remaining compensatory capacity is overwhelmed. Hence, conventional kidney function measures, such as glomerular filtration rate, do not adequately assess disease progression in ADPKD, especially in its early stages. Given the recent development of potential targeted therapies in ADPKD, it has become critically important to identify relevant biomarkers that can be used to determine the degree of disease progression and evaluate the effects of therapeutic interventions on the course of the disease. We review the current evidence to provide an informed perspective on whether total kidney volume (TKV) is a suitable biomarker for disease progression and whether TKV can be used as an efficacy end point in clinical trials. We conclude that because cystogenesis is the central factor leading to kidney enlargement, TKV appears to be an appropriate biomarker and is gaining wider acceptance. Several studies have identified TKV as a relevant imaging biomarker for monitoring and predicting disease progression and support its use as a prognostic end point in clinical trials., (Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: The religious beliefs and spirituality of patients on hemodialysis (HD) therapy have not been studied extensively. Studies of the dialysis population seem to indicate that religion may be associated with increased patient satisfaction with life and increased levels of social support., Methods: Using multiple religiosity scales and scales to assess patient satisfaction with life and social support, we studied the relationship between religiosity and medical and/or social factors and adherence to treatment in 74 HD patients., Results: High scores on the Intrinsic Religiosity Scale were associated strongly with high scores on the Satisfaction With Life Scale, whereas age and high Organizational Religious Activity Scale scores were associated strongly with high scores on the Satisfaction With Medical Care Scale. Older age was associated strongly with increased adherence. No relationship existed between religiosity and adherence in our population., Conclusion: Religious beliefs are related strongly to measures of satisfaction with life, whereas religious behaviors are related to satisfaction with medical care. Age is the single most important demographic factor associated with adherence. Because of the complex nature of religiosity, additional investigation is in order.

Here the authors report a case of refractory peritonitis leading to multiple hospitalizations and the loss of peritoneal dialysis access in a patient on automated peritoneal dialysis, caused by Asaia bogorensis, a bacterium not previously described as a human pathogen. This organism was identified by sequence analysis of the 16S ribosomal RNA gene. Unusual microbial agents may cause peritonitis, and molecular microbiological techniques are important tools for identifying these agents.

The kidney has been used for the last 50 years as a model system for the study of tissue inductions and vertebrate organogenesis. While much is known about the morphologic development of the kidney, it is only in the last few years that the molecular mechanisms involved in these processes have begun to be identified. This is largely a result of the identification of genes expressed during kidney development and the application of techniques for single gene disruption. Mammalian kidney development is described, and the methodology for single gene disruption is discussed. For a candidate gene to be unequivocally shown to be involved in organ development, three conditions are necessary. First, the gene must be spatially expressed correctly relative to the developing organ. Second, the gene has to be temporally expressed in a correct manner. Finally, when that gene is disrupted, normal organ development must not occur. There are now 11 genes that satisfy these conditions and thus have been shown to be crucial for metanephric kidney development: WT-1, Pax-2, c-ret, GDNF, alpha8beta1, Wnt-4, BF-2, BMP-7, PDGF B, PDGFRbeta, and alpha3beta1. These genes and their probable roles in kidney development are discussed, and some molecular pathways are suggested. Finally, the applications, limitations, and future trends in single gene disruption studies are discussed. Single gene disruption already has generated a wealth of information about kidney development and mammalian development in general. It is likely that this information is only the beginning, and many startling and profound discoveries can be expected in the years to come both from the utilization of knockout mice that already exist and those that will be created.