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This randomized trial assessed whether urate-lowering treatment with allopurinol could attenuate eGFR decline in at-risk patients with stage 3 or 4 chronic kidney disease. Allopurinol did not slow the decline in eGFR as compared with placebo.

ABSTRACT Background Previous reports on the prevalence of chronic kidney disease (CKD) in Asia have suggested important sex disparities but have been inconsistent in nature. We sought to synthesize available sex-disaggregated CKD prevalence data in Asia to quantify sex disparities in the region. Methods We systematically searched MEDLINE and Embase for observational studies involving ≥500 adults who reported sex-disaggregated CKD prevalence data in any of the 26 countries in East, Southeast and South Asia. For each study we calculated the female:male prevalence ratio (PR), with a ratio >1 indicating a higher female prevalence. For each country, log-transformed PRs were pooled using random effects meta-analysis. These were then combined using a fixed effects model, weighting by population size, to estimate a pooled PR for each of East, Southeast and South Asia and Asia overall. Results Sex-disaggregated data were available from 171 cohorts, spanning 15 countries and comprising 2 550 169 females and 2 595 299 males. Most studies (75.4%) came from East Asia (China, Taiwan, Japan and South Korea). Across Asia, CKD prevalence was higher in females {pooled prevalence 13.0% [95% confidence interval (CI) 11.3–14.9]} compared with males [pooled prevalence 12.1% (95% CI 10.3–14.1)], with a pooled PR of 1.07 (95% CI 0.99–1.17). Substantial heterogeneity was observed between countries. The pooled PRs for East, Southeast and South Asia were 1.11 (95% CI 1.02–1.21), 1.09 (0.88–1.36) and 1.03 (0.87–1.22), respectively. Conclusions Current evidence suggests considerable between-country and -region heterogeneity in the female:male PR of CKD. However, there remains a large part of the region where data on sex-specific CKD prevalence are absent or limited. Country-level assessment of the differential burden of CKD in females and males is needed to define locally relevant policies that address the needs of both sexes. Graphical Abstract Graphical Abstract

Background Hypertension is common in pregnant women presenting with aortic coarctation or Takayasu’s arteritis. Uncontrolled hypertension leads to increased adverse maternal and neonatal events. Case presentation A 36-year-old gravida 2, para 1 Caucasian woman presented at 9 weeks of gestation with headaches but normal blood pressure. She had a past medical history of an in vitro fertilization pregnancy complicated by preeclampsia at 27 weeks of gestation (birth weight 1900 g) and infrarenal aortic stenosis. In the current pregnancy, she received aspirin and calcium as preeclampsia prophylaxis, remained normotensive throughout pregnancy, and was delivered by elective cesarean section at 37 weeks without complications. Conclusions This case demonstrates a significant chronic aortopathy in pregnancy with normal fetal growth and uterine blood flow through collateral supply from the internal mammary and epigastric arteries.