Issue 2, 2010 July 2010 Welcome to the second issue of Kidney and Blood Pressure Research Digest (KBPR Digest) in 2010. We would like to draw your attention to articles of outstanding importance in the field of nephrology and hypertension, presenting 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 will be inspired to get to know more about the articles which are presented below. Professor Thomas Quaschning, MD, PHD On behalf of the Editorial Board of Kidney and Blood Pressure Research mail@thomas-quaschning.de   Digest of issue 2/2010 Issue 2/2010 of Kidney and Blood Pressure Research covers a wide spectrum of clinical and preclinical topics. It contains a study which explores the impact of the mTOR pathway in autosomal recessive polycystic kidney disease as well as an analysis of the association between albuminuria and arterial stiffness in type 2 diabetic patients. A third manuscript highlights the impact and design of the IRIDIEM study which evaluates cardiorenal risk factors in diabetic patients. An inappropriate activation of the mTOR pathway was demonstrated in the autosomal dominant form of polycystic kidney disease (PKD). This led to the development of novel therapeutic strategies which are at present under evaluation in large-scale clinical trials. To date it is unclear whether the mTOR pathway is activated in autosomal recessive PKD, a cystic disease which occurs in childhood. The purpose of the present study by Becker and colleagues (Kidney Blood Press Res 2010;33:129-138) was to evaluate the mTOR pathway in autosomal recessive PKD by immunostaining of corresponding molecules. Therefore, the authors examined the expression of mTOR pathway molecules in paraffin-embedded liver and kidney samples from patients with autosomal recessive PKD and control specimens. The authors demonstrated that mTOR was strongly expressed in renal cyst-lining cells and bile ducts from autosomal recessive PKD specimens. S6K immunostaining was strong in smaller tubules - confirming the data of a recent study by Shillingford et al. (Proc Natl Acad Sci USA 2006; 103: 5466-5471) - and was weak both in larger renal cysts and in the bile duct epithelium, whereas 4E-BP1-immunostaining was restricted to noncystic tubules in AR PKD. eIFG4-immunostaining was observed in bile duct epithelium in autosomal recessive PKD, but not in control tissue. In summary, the data of Becker et al. indicate an activation of the mTOR pathway in autosomal recessive PKD similar to the pathophysiological changes in autosomal dominant PKC. Therefore, mTOR molecules may represent a potential target to slow down cyst development also in the autosomal recessive form of polycystic kidney disease. In the 20th century, cardiovascular disease (CVD) became the main cause of mortality and morbidity in Western populations. The risk of coronary artery disease in type 2 diabetes patients is even six times higher than in the general population. Therefore, the development of methods to estimate the risk of CVD in diabetes patients is highly desirable and may contribute to prevent CVD incidence as well as to lower the disease burden of diabetes. To evaluate the association between albuminuria, carotid atherosclerosis, arterial stiffness, and peripheral arterial disease (PAD) in type 2 diabetic patients, Korean scientists (Kidney Blood Press Res 2010;111-118) examined 673 patients with type 2 diabetes registered in three Korean public health centers. Following an overnight fast, venous blood and urine samples were collected and analyzed. The carotid intima-media thickness (IMT), amount of carotid plaques, brachial ankle pulse wave velocity (PWV), and the ankle-brachial index (ABI) of each patient were also assessed. The authors demonstrated that in diabetic patients, albuminuria was significantly associated with PAD but not with the amount of carotid plaques. The mean PWV differed significantly according to the level of the albumin-creatinine ratio, whereas no significant difference was observed in the mean IMT values. Despite its limitations, this study is valuable in evaluating the association between various subclinical atherosclerosis phenotypes, such as IMT, amount of carotid plaques, ABI, and PWV in a single population. The authors showed that albuminuria was significantly associated with PWV and PAD, but not with the amount of carotid plaques or IMT in the carotid artery. Additional prospective studies will be required to further evaluate the pathophysiological mechanisms underlying the presence or absence of these associations in type 2 diabetic patients. The continuing rise in incidence of type 2 diabetes is predicted to lead to a doubling in cases from 171 million patients in 2000 to a projected 366 million patients by 2030. Type 2 diabetes is a leading cause of chronic kidney disease (CKD), accounting for 44% of the primary causes of kidney failure, and is the most common primary comorbidity associated with end-stage renal disease. The purpose of the Individual Risk-Profiling and Treatment in Diabetes Management (IRIDIEM) study (Kidney Blood Press Res 2010;33:119-128) was to evaluate the characteristics of CKD and associated comorbidities in patients with type 2 diabetes and CKD. IRIDIEM was conducted as a cross-sectional survey in 109 centers in 11 countries and included 1,205 patients aged 50 years or less with type 2 diabetes for 5 years or more and CKD stage 2-4. 50% of patients were in CKD stage 4; 42% had CKD stage 3, and 4% were in CKD stage 2. Concomitant risk factors for cardiovascular disease and/or progression of CKD included hypertension (92% of patients), proteinuria (74%), hypercholesterolemia (65%), and hypertriglyceridemia (44%). Only 64% of patients with hypertension had received antihypertensive medication. Anemia was present in 34% of patients and increased markedly with advanced CKD stages. Of patients with documented anemia, only 19% had received epoetin, and only 7% had received iron treatment. The IRIDIEM study clearly documents the need to improve adherence to current best-practice guidelines for management of cardiorenal risk factors including earlier initiation of antihypertensive treatment, lipid and anemia management in this high-risk patient population. It will therefore be of great value for all physicians taking care of diabetic patients with CKD. For submission of articles or sign-ups to ToC Alerts, please go to the journal's homepage © S. Karger AG - Medical and Scientific Publishers Allschwilerstrasse 10, P.O. Box, CH-4009 Basel (Switzerland) Tel. +41 61 306 1200, Fax +41 61 306 1234, publications@karger.com. Please read the Karger Privacy Policy. If you have received this email by mistake, click here and we will take you off this mailing list.