Religious concerns may be an important reason why patients decline listing for a renal transplant. These issues may be equally, or even more, important when live donation is discussed. There is good reason to believe that religious concerns play a significant role much more often than clinicians and transplant teams believe. The issue is certainly further compounded by the fact that a few, if any, patients come forward with their religious concerns, not least because issue of transplantation is new to them anyway and because they meet with transplant teams whom they do not know. Health professionals, on the other hand, may wish to avoid this sensitive issue altogether or may lack knowledge on religious issues pertaining to transplantation. Some may be entirely unaware. We encountered a case in clinic that revealed our remarkable lack of knowledge in this regard. Here, we aim to provide an overview on how the different religions view transplantation and organ donation, with an emphasis on practical points for health care professionals who are involved in transplant listing, organ donation and retrieval, and transplantation itself. Knowledge of these facts may provide a background to deal with these issues professionally and appropriately and to increase transplant numbers.

Discontinuation of ACEi/ARB has undoubtedly delayed the onset of RRT in the majority of those studied. This observation may justify a rethink of our approach to the inhibition of the RAAS in patients with advanced CKD who are nearing the start of RRT.

The extracellular matrix (ECM) is in a continual state of turnover with homeostasis maintained by balancing synthesis and degradation rates. During progressive kidney scarring an imbalance occurs leading to ECM accumulation. Reduced matrix metalloproteinase (MMP) activity is believed to central to this imbalance. However, most of the data relating to MMPs and their natural inhibitors (tissue inhibitors of matrix metalloproteinase (TIMP)) is based on homogenate studies where in situ compartmentalization is lost and thus changes in MMP activity may be artificial. To address this we have developed a sensitive, high-resolution in situ zymography technique and applied it, along with immunohistochemistry, to the 5/6th subtotal nephrectomy model of kidney scarring. ECM proteolytic activity in kidney homogenates progressively declined post-SNx against both gelatin (-82%) and collagen I (-78%) substrates. In situ zymography revealed higher activity with both substrates within the cytoplasm of normal tubular cells compared to the SNx. In contrast, there was 96% greater activity in the SNx glomeruli than normal. Immunohistochemistry confirmed a predominantly intracellular tubular location of all MMPs and TIMPs. Tubules showed reduced MMP-3 and elevated TIMP-2, whereas MMP-1 increased significantly in the glomeruli, especially in the mesangial matrix. TIMP-1 showed a fourfold increase in the remnant kidney by Western blot analysis, but could not be localized. Lowered MMP activity in homogenates results from reduced intracellular activity in the tubules, indicating that reduced MMP activity may not play a direct role in the expansion of the tubular ECM in scarring. However, elevated MMP-1 activity in the glomeruli may play a significant role in initiating glomerular remodelling.