Issue 4, 2010 May 2010 I strongly encourage the readers of Nephron Digest to engage in a dialogue by emailing me to discuss issues of global nephrological interest. These would be addressed by expert members of the editorial board of Nephron. Also readers are encouraged to request topics that they would like to be updated upon through the Mini Review series of Nephron Clinical Practice. Professor Meguid El Nahas, PhD, FRCP Editor, Nephron Clinical Practice nephron@sheffield.ac.uk m.el-nahas@sheffield.ac.uk   Digest of issue 116/1/2010 Treatment of Primary Systemic Vasculitis with the Inosine Monophosphate Dehydrogenase Inhibitor Mycophenolic Acid (T.F. Hiemstra, R.B. Jones, D.R.W. Jayne, UK; Nephron Clin Pract 2010;116:c1-c10) This minireview focuses on recent developments in the use of salts of mycophenolic acid (mycophenolate mofetil and mycophenolate sodium) in systemic vasculitis associated with antineutrophil cytoplasmic autoantibodies (ANCA+ vasculitis, AASV). The authors review the promise of these agents in this type of vasculitis and caution against premature enthusiasm. They remind the readers that these agents have not yet achieved first-line treatment status. Trials are underway (MYCYC and IMPROVE) that may confirm their potential in inducing remission and maintaining it, respectively. Meanwhile, it is important to remember that steroids and cyclophosphamide are considered the "treatment of choice" in AASV. However, the potential toxicity of cyclophosphamide, especially in older patients, warrants the search for alternatives. It is intriguing that cyclophosphamide was never compared, or shown to be superior, to another old-fashioned antimetabolite, azathioprine, in inducing remission in AASV. This shows that "treatments of choice" are often based on "expert" opinions and/or bias and not always on sound clinical evidence. Without strong evidence I have always favoured azathioprine over cyclophosphamide in older patients (>65years) with AASV. Perhaps another example of bias over evidence! Chronic Kidney Disease in Older People: Physiology, Pathology or Both? (A.H. Abdelhafiz et al., UK; Nephron Clin Pract 2010;116:c19-c24) In this review, the authors explore the true nature of CKD in older people. Emphasis is on whether age-related changes in kidney function are physiological or pathological. It is concluded that CKD in the elderly, which constitutes the bulk of the so-called CKD "epidemic", is merely the reflection of vascular ageing and consequent kidney damage with microalbuminuria and reduced GFR. The kidney is one of many affected target organs along with the heart, brain and eyes. A recent publication coins the term Cardio-Kidney-Damage (C-K-D) to describe this entity (El Nahas, Kidney Int advance online publication 5 May 2010; doi: 10.1038/ki.2010.123). This may be a preferable term to "disease" as otherwise older people would be plagued with so many diseases; heart disease, kidney disease, lung disease, brain disease, hearing disease, eye disease, not to mention hair disease - for those who also lose their hair! Ageing after all can be cruel. Nephrology Guidelines Synopsis In this issue, Dr. Arif Khwaja has started his review of current nephrology guidelines by summarising and commenting upon two KDIGO guidelines. Chronic Kidney Disease-Mineral and Bone Disorder KDIGO Guidelines (A. Khwala, UK; Nephron Clin Pract 2010;116:c25-c26. For a summary, see table: KDIGO Guidelines for Care of the Kidney Transplant Recipient (A. Khwala, UK; Nephron Clin Pract 2010;116:c27-c28. For a summary, see table: For previous issues of Nephron Digest or to sign up for future issues, click here. For submission of articles, sign-ups to ToC Alerts or to recommend Nephron Clinical Practice to your librarian, 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.ch. 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.