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The complement system is often involved in immune-driven kidney injury. In this Review, the authors discuss complement activation in a variety of kidney diseases, including conditions not traditionally considered to be immune-mediated, and the potential of complement therapeutics for the treatment of kidney disease.

A recent study reports that adenosine A2A receptor-mediated lymphangiogenesis increases lymphatic clearance of excess Na⁺ from the skin and reduces blood pressure, whereas impairment of this process leads to salt-sensitive hypertension. These findings raise intriguing physiological questions regarding the relationships among sodium, water and blood pressure.

This Review summarizes our current understanding of sex differences in renal fluid and electrolyte transporters, based primarily on studies in rodents. The authors describe the physiological consequences of these differences, based on information from experimental studies and from model predictions, and discuss the differential impact of sex on transporter regulation by hormones, diet and acid–base status.

Here, the authors review the current understanding of interorgan crosstalk mechanisms, with a focus on interorgan communication in the kidney–lung axis during acute or chronic disease of the kidney or lung.

Several factors complicate the identification of effective interventions that can improve the outcomes of patients with acute kidney injury (AKI). Here, the authors discuss key design considerations for clinical trials in hospitalized patients with AKI, including the selection of adequate patient cohorts and study end points.

Digital transformation offers unprecedented opportunities for advancing healthcare, but also raises complex ethical and legal challenges. Emerging drivers of health disparity termed ‘digital determinants of health’ call for purposeful, equity-focused strategies to ensure that technological innovation benefits all without exacerbating disparities.

Primary aldosteronism is the most common cause of endocrine arterial hypertension and is characterized by the autonomous production of aldosterone from one or both adrenal glands. This Review describes the molecular discoveries and developments that have the potential to transform the clinical management of patients with this disease.

Here, the authors review techniques for cardiovascular diagnosis, screening and monitoring in patients with CKD, including approaches to the diagnosis of cardiac ischaemia, left ventricular hypertrophy and dysfunction, arrhythmia, cerebrovascular disease, peripheral arterial disease, arterial stiffness and hypertension.

Perivascular cells have beneficial roles that maintain kidney homeostasis but can also contribute to kidney pathology. Here, the authors focus mainly on pericytes and fibroblasts to examine these roles, including the contribution of perivascular cells to the myofibroblast pool in kidney fibrosis, and their crosstalk with tubular, immune and endothelial cells.

The diagnosis of glomerular disease relies largely on meticulous histological and laboratory investigations that continue to improve with technological advances. However, low-income countries such as Uganda lack this investigatory armamentarium and patients are often treated on the basis of suboptimal evidence.

Among global destabilizing events, natural disasters often receive widespread attention whereas protracted conflicts and economic crises fade into the background. Low- and middle-income countries bear the brunt of this indifference, resulting in severely weakened health systems. People who require dialysis are particularly vulnerable, necessitating urgent collaboration to ensure equitable and sustainable care during such crises.

Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of the disease. The authors of this Review describe the different inequities that affect kidney health and care worldwide, and consider potential solutions to help to mitigate these.

In this Consensus Statement, the authors discuss a framework for the development, validation and implementation of digital health technologies across the acute kidney injury continuum — risk prediction, prevention, detection and management.

Racial and ethnic minoritized populations are underrepresented in clinical trials in nephrology, but overrepresented in adverse kidney disease outcomes. Targeted enrolment, revision of problematic policies, inclusion of minoritized populations in trial planning, and language-, race- and ethnicity-concordant investigative teams can improve representation in clinical trials.

Acute kidney injury (AKI) is a global concern that affects patient outcomes and resource utilization. An effective educational programme aimed at improving early AKI identification, triaging and treatment, using risk scores and care bundles coupled with access to point-of-care diagnostics, can help to prevent AKI-related deaths in regions with limited resources.