BK virus-associated nephropathy in renal allograft recipients: rescue therapy by sirolimus-based immunosuppression.

Background: BK virus nephritis (BKN) in recipients of renal allografts has reemerged during the past 5 years. Despite increased incidence, therapeutic options remain limited and progression of the disease often leads to allograft failure.

Methods: From May 2002 to July 2002, we performed protocol biopsies in 25 recipients of kidney allografts with progressive allograft dysfunction; three patients demonstrated unexpected histopathologic features of BKN.

Pyelonephritis and acute renal failure.

Bacterial invasion of the renal parenchyma, pyelonephritis, is rarely considered as a primary cause of acute renal failure, particularly in adults. We report two cases of acute renal failure occurring in absence of hypotension, urinary tract obstruction, or nephrotoxic medications that are likely the direct consequence of pyelonephritis. The first case involved a 48-year-old HIV-positive woman who presented with 3 days of nonspecific symptoms and was noted to have acute renal failure.

The tissue renin-angiotensin-aldosterone system in diabetes mellitus.

Diabetes is associated with an inordinate burden of cardiovascular and renal disease, which is expected to accelerate during the next few decades. The relationship between the renin-angiotensin system (RAS) and diabetic macrovascular and microvascular disease is well established. The contribution of the tissue RAS in disease pathogenesis has recently been the focus of much interest, and has prompted investigators to explore the use of high-dose RAS inhibition with monotherapy or combination therapy to provide a more complete blockade of the actions of angiotensin II, beyond lowering blood pressure.