The results of this study provide evidence for safe conversion from Tacrolimus BID to QD with appropriate trough concentration monitoring.

In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at ≤140/90 mmHg. When CKD is present, especially where there is proteinuria of ≥0.5 g/day, the goal is a BP of ≤130/80 mmHg. Lifestyle measures are mandatory, especially limitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 -5 CKD must be carefully monitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitored and, where possible, home BP-measuring devices are recommended for optimal control.Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients with stages 4 -5 CKD.There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV.

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Behind the satisfying hum of scientific progress, we hear the drumbeat of scientists pushing and shoving. Concerns surface constantly about research integrity, reproducibility and pressure to publish. We need to draw on the history of science and kindle the benefits of three contemplative but immensely practical ideals: reticence, intimacy and innocence. To be reticent is to reflect on the significance of our work. Pausing can make for better science. Describing the 16-year delay in publishing his book on insectivorous plants, Darwin wrote that "…a man after a long interval can criticize his own work, almost as well as if it were that of another person". The advice remains good today: consider the alarms over humangenome editing. The precept of intimacy lifts our research beyond the collection of measurements and data. Think of the gifted cytogeneticist Barbara McClintock, whose biography was entitled A Feeling for the Organism. Or the evolutionary theorist Lynn Margulis, who instinctively navigated the complex biological systems of Massachusetts' Sippewissett marshes (see D. Sagan (ed.) Lynn Margulis: The Life and Legacy of a Scientific Rebel; Chelsea Green Publishing, 2012). Scientific innocence means that ideas-not money or fametake centre stage. We are modest, open to fresh perspectives and new approaches. We take time for exploratory discussions and to listen. Let the conversation begin.

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