Issue 1, 2009May 11, 2009 Welcome to the first issue of Kidney and Blood Pressure Research Digest (KBPR Digest). To draw your attention to articles of outstanding importance in the field of nephrology and hypertension, we have decided to present short summaries of these articles to the scientific community in the form of KBPR Digest. KBPR Digest provides readers from all over the world with a free and concise overview on interesting topics which are part of the current issue of Kidney and Blood Pressure Research. We hope that you are attracted by this new format and that you will be inspired to get to know more about the details of the articles which are discussed below. Moreover, a congress calender is included to give you an overview of the important meetings in the field. Professor Thomas Quaschning, MD, PHD In behalf of the Editorial Board of Kidney and Blood Pressure Research mail@thomas-quaschning.de   Digest of issue 2/2009 Issue 2/2009 of Kidney and Blood Pressure Research contains two articles which highlight the role of the biomarker neutrophil gelatinase-associated lipocalin (NGAL) in the early detection of kidney injury and regarding the classification of the severity of impaired renal function. A third article investigates the role of mean arterial pressure and mortality in chronic hemodialysis patients. Biomarkers are under investigation in virtually every field of medicine - either to monitor activity and progression of disease or to indicate the presence of disease even before clinical symptoms occur. Therefore, biomarkers may be considered in some way as "magic parameters" which help to make invisible things become evident. The group of Michele Buemi in Messina, Italy, explored NGAL as an early biomarker of diabetic nephropathy (Kidney and Blood Pressure Research 2009;32:91-98). NGAL is a small (25-kDa) molecule originally obtained from the supernatant of activated neutrophils. However, it is also known to be hyperproduced in kidney tubules within a few hours after damaging experimental stimuli. In addition, the tubular secretion of NGAL is correlated with the severity of chronic renal impairment such as in autosomal dominant polycystic kidney disease or glomerulonephritis. In a cohort of 56 patients with type 2 diabetes mellitus, the researchers demonstrated increased levels of NGAL in both serum and urine. Furthermore, levels of NGAL corresponded with the severity of renal damage (normalbuminuria vs. microalbuminuria vs. overt diabetic nephropathy). At present, the detection of microalbuminuria is considered to be an early marker of diabetic nephropathy. It is of note that NGAL is elevated in serum and urine even before albumin occurs in the urine. In consequence, NGAL may become a useful and noninvasive tool for the evaluation of renal involvement in diabetic patients, thus accelerating the early diagnosis of diabetic nephropathy. Poniatowski and coworkers from the Medical University of Bialystok, Poland, investigated the prognostic value of NGAL in a different cohort of patients (Kidney and Blood Pressure Research 2009;32:77-80): They studied 150 patients with chronic heart failure due to coronary artery disease, demonstrating a correlation between estimated GFR and Cystatin C - as established markers of renal function - and the levels of NGAL in serum and urine of the patients. Particularly in patients with only minor elevation in serum creatinine, NGAL has proven to be a useful early marker for renal impairment. This has been shown for children and adults with chronic kidney disease before and can now also be transferred to patients with heart failure. Furthermore, Poniatowski et al. demonstrated a correlation between NGAL concentration and NYHA class of heart failure, indicating a close relation between congestive heart failure and impairment of renal function. Similar to diabetic patients, NGAL has proven to be an early and sensitive marker of kidney injury in patients with heart failure. Beyond the value of biomarkers, this study may support the idea that cooperation of cardiologists and nephrologists in patients with congestive heart failure and chronic kidney disease may improve the quality of care and may substantially improve the patient's prognosis. The management of blood pressure in dialysis patients requires fundamental knowledge of the pathophysiology of blood pressure regulation in chronic kidney disease and a good piece of clinical experience in handling dialysis patients. Wang and coworkers evaluated the association between mean arterial pressure and mortality in chronic hemodialysis patients in a chinese-taiwanese cooperation (Kidney and Blood Pressure Research 2009;32:99-105). In a cohort of 834 chronic hemodialysis patients, 205 patients died during an average follow-up period of 36.2 months. Leading causes of death were - typical for this population - cardiovascular disease (52.7%) and infections (25.9%). Patients with predialytic mean arterial pressure (MAP) < 90 mm Hg and patients with an increase in MAP > 15 mm Hg during hemodialysis sessions were associated with increased mortality. Every 1 mm Hg increase in MAP during hemodialysis was associated with a 3% increase in risk of death. As MAP is determined by cardiovascular output and peripheral vascular resistance, low MAP may indicate low cardiovascular output due to left-ventricular dysfunction, which is associated with enhanced mortality. Until now, the mechanism of increase in MAP during dialysis is poorly understood. Contributing factors may include the removal of antihypertensive substances, fluctuation in electrolytes, activation of the renin-angiotensin-system and elevated sympathetic response. It is surprising that in the 21st century, elevation of blood pressure during hemodialysis is still a non-resolved issue. Scientific evaluation of this phenomenon is even more required since blood pressure is easy to influence and therefore - once the pathophysiology is understood - mortality of dialysis patients may be significantly reduced.   Congress Calendar ESH 2009 19th European Meeting on Hypertension Milan, June 12-16, 2009 Joint Meeting of the Brazilian Society of Hypertension and the Inter-American Society of Hypertension Belo Horizonte, August 5-8, 2009 Artery 9 Cambridge, September 9-12, 2009 Japanese Society of Hypertension Annual Meeting Otsu, October 1-2, 2009 WCH 2009 World Hypertesion Congress Beijing , October 29 - November 1, 2009 In conjunction with The 11th International Symposium on Hypertension and Related Diseases 2nd International Conference on Fixed Combination in the Treatment of Hypertension, Dyslipidemia and Diabetes Mellitus Valencia, September 10-12, 2009 ESH 2010 20th European Meeting on Hypertension Oslo, June 18-22, 2010   © S. 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