Volume 14 Issue 2, February 2018

New findings in 2017 enhanced our understanding of the mechanisms that regulate blood pressure. Key studies provided insights into immune mechanisms, the role of the gut microbiota, the adverse effects of perivascular fat and inflammation on the vasculature, and the contribution of rare variants in renin–angiotensin–aldosterone system genes to salt sensitivity.

Studies of cellular energetics have revealed important roles of metabolic pathways in determining cell fate and response to injury. Insights from 2017 into the mechanisms underlying these pathways might identify therapeutic targets to minimize injury and promote repair.

In 2017, progress was made in several aspects of immune-mediated kidney disease. Mechanistic studies provided new insights into the underlying signals that confer risk to, or protection from, immune pathways, whereas new approaches to the treatment of immunological kidney disease will hopefully translate into a move away from the use of toxic corticosteroids.

2017 saw the emergence of a new era in renoprotective medicine for diabetic kidney disease with reports of promising renal outcomes with the sodium–glucose cotransporter 2 (SGLT2) inhibitors empagliflozin and canagliflozin from follow-up analyses of the EMPA-REG OUTCOME trial and the CANVAS Program, respectively, and with use of the glucagon-like peptide 1 (GLP1) agonist liraglutide in the LEADER trial.

Technical advances in genome sequencing and association studies have yielded critical insights into the genetic architecture of kidney diseases. Here, I summarize four key studies from 2017 that deciphered the genetic basis of known and novel diseases and provided insights into the mechanisms of glomerular, developmental defects and manifestations of kidney disorders.

Genomic medicine approaches are increasingly used for diagnosis of kidney disease. Here, the authors discuss sequencing modalities, the interpretation and clinical application of genetic data, and the challenges that must be overcome to realize the potential of genomic medicine in nephrology.

Adipose is an important endocrine and immunologic organ, releasing various adipokines and cytokines that regulate the adipocyte microenvironment and systemic metabolism. Here, the authors discuss the immunologic and endocrine functions of adipose tissue that contribute to kidney disease and the converse effects of kidney dysfunction on adipose tissue.

Sepsis induces an initial activation of the immune system, which is often followed by a compensatory anti-inflammatory response that can lead to immunosuppression. In this Review, the authors discuss advances in the understanding of sepsis-induced immunosuppression and how this understanding might lead to new, more effective treatments for sepsis.