Practicing evidence-based medicine can be difficult in nephrology, where randomized controlled trials are few and far between. In general, the more that trials use hard outcomes such as morbidity and mortality, the greater our confidence that the therapies will have an impact on patients' lives. Using end points such as these, however, often require large sample sizes.

Hypertension is the most important risk factor of mortality, accounting for about 12% of all deaths worldwide. Time and again, lowering BP has proved to be beneficial in randomized controlled trials. Still, a number of questions remain about the effects of antihypertensive therapy in patient groups that are excluded from most clinical trials.

Most physicians in this country provide patient care in busy private practice offices or non-teaching hospitals. Practicing physicians often try to adhere to relevant guidelines to optimize patient care and achieve better outcomes. The guidelines, however, are usually developed by certain groups of opinion leaders and experts who are mostly, if not exclusively, academicians from renowned universities or research centers.

The 2008 Genitourinary Cancers Symposium in San Francisco featured a session on anticipating failure in the patient with advanced prostate cancer. Anthony Zietman, MD, the Jenot and William Shipley Professor of Radiation Oncology at Harvard Medical School in Boston, made his case for the use of adjuvant external beam radiation therapy. Adam Kibel, MD, associate professor of surgery in the division of urologic surgery at Washington University School of Medicine in St. Louis, argues in favor of systemic treatment.

The broad application of cross-sectional imaging has led to the incidental discovery of small renal masses (SRM) as the most common presentation for localized kidney cancer. As this stage migration unfolded, technological efforts at nephron preservation via open, laparoscopic, and robotic assisted techniques have evolved. Moreover, excision by partial nephrectomy is associated with excellent long term oncologic success.

Two articles in this issue relay new findings on one of the most pressing and controversial issues in nephrology: increasing the number of donor kidneys available for transplantation. The solution examined in each article is the use of more kidneys from expanded criteria donors (ECD).

The kidney-care community can point to more than 30 years of clinical accomplishments. In particular, the past 10 years have been marked by steady improvement in patient access to dialysis centers and improvement in clinical outcomes. Still, important challenges remain. The renal community must understand these challenges and continue the tradition of developing innovative programs to assist nephrologists in overcoming them in the future.

DURING THE past five years, the da Vinci robot has increasingly been used to perform radical prostatectomies. This robotic technology has revolutionized prostate cancer surgery. Among other benefits, the robot enables the surgeon to perform the operation in three dimensions (3D). Assisting surgeons, however, have had to view the procedure in two dimensions (2D).

AS PATIENTS, physicians, dialysis providers, and payers search for more favorable outcomes in patients with end-stage renal disease (ESRD), alternative dialysis regimens have gained popularity. Among these therapies are dialysis treatments that are performed more frequently, for longer periods of time, and/or at the patient's home.

On September 11, 2007, an FDA panel of health experts declined to recommend the quasi-expected restrictions on the use of the erythropoietin stimulating agents (ESA) in CKD patients. For years, the three FDA-approved ESAs (Aranesp, Epogen, and Procrit) have been heavily prescribed for anemia without much concern about serious adverse effects.