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  • Patients with chronic kidney disease often require complex polypharmacy, require dose adjustments or discontinuation with changes in kidney function, and can be susceptible to the adverse effects of medications. This Review discusses the principles of drug stewardship — that is, the effective, safe and sustainable use of medications — for people with chronic kidney disease.

    • Rasheeda K. Hall
    • Rümeyza Kazancıoğlu
    • Juan J. Carrero
    Review Article
  • In this Review, the authors examine the biophysical and biomechanical properties that influence podocyte physiology as they integrate and adapt to stimuli from their dynamic environment within the glomerular capillaries. The authors also discuss how dysregulation and loss of biomechanical resilience in podocytes can contribute to kidney disease.

    • Jonathan Haydak
    • Evren U. Azeloglu
    Review Article
  • Care for patients with tuberous sclerosis complex (TSC) should be coordinated by a multidisciplinary team. This Consensus Statement, which involved input from nephrologists, urologists, geneticists, radiologists, interventional radiologists and pathologists as well as patient representatives, provides an overview of TSC-associated kidney manifestations and outlines current recommendations for the management of kidney involvement in TSC.

    • Djalila Mekahli
    • Roman-Ulrich Müller
    • John Bissler
    Consensus Statement
  • Haemodialyser technology has not advanced much in decades, despite its unresolved shortcomings. Sophisticated new computational tools such as high-fidelity surrogate in silico dialyser models could reduce the time and expense of exploring alternative designs, dialysis dose and operating conditions compared with the current gold standard in vitro studies.

    • Ruhit Sinha
    • Michael V. Rocco
    • Anne E. Staples
    Comment
  • Global inequities and inequalities, human and health-care crises, transplantation successes in the face of limited organ availability, and desperate donors and recipients underlie the backstory of organ trafficking, namely the exploitation of the most vulnerable. Despite the framework set out by the Declaration of Istanbul for the ethical donation and transplantation of organs, organ trafficking remains a global challenge.

    • Thomas F. Mueller
    • Sanjay Nagral
    Comment
  • Renal nanomedicines may hold promise for the detection and treatment of a variety of kidney diseases. This Review describes how our understanding of the physiological principles that regulate the glomerular filtration, tubular secretion, luminal tubular uptake and re-elimination of nanoparticles in the kidneys may facilitate the selective targeting of nanomedicines to specific segments of the nephron.

    • Yingyu Huang
    • Xuhui Ning
    • Jie Zheng
    Review Article
  • A number of epidemiological studies have linked markers of underhydration with an increased risk of adverse health outcomes. This Review provides an overview of the mechanisms that regulate body water balance and the adaptive responses to decreased hydration, and describes current understanding of the physiological consequences of underhydration on health outcomes.

    • Natalia I. Dmitrieva
    • Manfred Boehm
    • Sofia Enhörning
    Review Article
  • This Review summarizes the roles of sirtuins in kidney development, physiological processes and the pathogenesis of acute and chronic kidney diseases. The authors also highlight the potential of sirtuins as therapeutic targets to limit human kidney disease and renal ageing.

    • Luca Perico
    • Giuseppe Remuzzi
    • Ariela Benigni
    Review Article
  • Improved understanding of the interrelated nature of cardiovascular, kidney and metabolic (CKM) health, the development of novel risk prediction equations, and the availability of powerful new therapies provide an opportunity to change the course of CKM health. Achieving such change at a population level will require additional advances to deliver equitable interdisciplinary care.

    • Susan E. Quaggin
    • Benjamin Magod
    News & Views
  • Chronic kidney disease is associated with a graded and independent excess risk of sensorineural hearing loss. This Review describes how disruption of shared signalling pathways that are important for the development of both the ear and the kidney and/or the presence of clinical drivers, such as specific medications or treatments, may underlie these associations.

    • Dina Greenberg
    • Norman D. Rosenblum
    • Marcello Tonelli
    Review Article
  • The availability of antiretroviral therapy has led to a transformation in the spectrum of kidney diseases associated with HIV infection. This Review describes the changing pattern of kidney diseases associated with HIV infection, their risk factors, methods of evaluating kidney function in patients with HIV and current therapeutic approaches.

    • Nina E. Diana
    • Saraladevi Naicker
    Review Article
  • All patients with kidney disease have the right to have a say in their own clinical care, the provision of health services and research into kidney disease. Patient empowerment and advocacy, especially for those whose views are seldom heard, can be enhanced by working together in communities.

    • Miranda Scanlon
    Comment
  • Renal cell carcinoma is a metabolic disease linked to a variety of alterations in genes that regulate cellular metabolism. Here, the authors examine cell-intrinsic metabolic alterations in hereditary and sporadic renal cell carcinoma, and how they can be exploited to develop novel therapeutic interventions.

    • Nathan J. Coffey
    • M. Celeste Simon
    Review Article
  • Treatment of chronic kidney disease requires a comprehensive approach including universal access to early diagnosis and to medications that can slow disease progression. Such equitable access is not only an ethical requirement but can also reduce the financial and human costs of advancing kidney and cardiovascular disease.

    • Ricardo Silvariño
    • Laura Solá
    Comment