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The demand for kidney transplants is far from met by human donors — a problem that may be solved by the clinical translation of porcine kidney xenotransplantation. A new paper describes the development of genetically ‘humanized’ pigs, the kidneys of which kept nephrectomized cynomolgus macaques alive for up to 2 years.

The current nomenclature for cardiorenal syndrome is problematic owing to its chronological approach and the systemic nature of some of the subtypes. We suggest adoption of a new concept, chronic cardiovascular–kidney disorder, that better reflects the contributions of common risk factors and shared pathophysiological mechanisms.

In this Review, Franck Mauvais-Jarvis discusses how adaptive selection during evolution could have shaped sex differences in energy partitioning, adipose tissue function and distribution, and glucose homeostasis. He also discusses the hormonal and genetic mechanisms that underlie these sex differences and their implications for metabolic disease and sex-based precision medicine.

Clonal haematopoiesis of indeterminate potential (CHIP) is associated with increased risk of disease, including cardiovascular and kidney disease. Here, the authors discuss the consequences of CHIP across various organ systems, including direct and indirect effects on kidney health.

The compartmentalized structure of primary cilia is maintained via interconnected barrier and active transport systems and underlies its unique composition and function. This Review describes the major compartmentalizing pathways that occur at the cilium and how insights into cilia transport and barrier mechanisms have shed light on the mechanisms underlying ciliary diseases.

First Nations peoples in Australia face systemic inequities in access to kidney transplantation. The National Indigenous Kidney Transplant Taskforce was established to address these. It has provided support to clinicians to implement and evaluate innovative practices and developed strategies to address biases in the structures and models of care that create barriers to wait-listing.

Although potentially harmful in excess, reactive oxygen species (ROS) also act as signalling molecules and contribute to cell survival. This Review describes the relevance of ROS to physiological processes and disease pathogenesis with a focus on the kidney. The authors also outline the current status of clinical trials that aim to target ROS signalling in humans.

The family of melastatin-like transient receptor potential (TRPM) channels comprises eight multifunctional cation channels. Here, the authors examine the functional role of each TRPM channel, including insights from channelopathies, and discuss the implications for kidney homeostasis and pathology.

New clinical studies suggest that mesenchymal stem cell (MSC) therapy can have positive clinical effects, potentially via immunomodulation, in patients with diabetic nephropathy or nephrotic syndrome. These trials suggest that the therapy is safe, but adverse reactions highlight the need to examine the source and functional attributes of MSCs closely.

Here, the authors discuss the pathophysiology of acute kidney injury (AKI) in patients with burns, approaches to prevention and management of AKI in this population and the application of AKI biomarkers and artificial intelligence approaches to guide treatment and predict short-term and long-term outcomes.

Biomolecular condensates are membraneless compartments that typically contain proteins and RNAs and broadly affect many cell types and organs. In the kidney in particular, rapid and reversible assembly of biomolecular condensates occurs through the process of hyperosmotic phase separation. This Review describes emerging evidence for, and the impact of, biomolecular condensates on kidney physiology and disease.

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.