Microbiology articles within Nature Reviews Nephrology

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  • Review Article |

    This Review examines the role of alterations in the gut microbial ecosystem, as well as inflammation and oxidative stress, in the bone and mineral disorder that affects patients with chronic kidney disease. The authors also explore novel therapeutic options that can target these disease factors.

    • Pieter Evenepoel
    • , Peter Stenvinkel
    •  & Roberto Pacifici

  • Review Article |

    The gut microbiota is increasingly recognized as an important factor in human health and disease. Here, the authors focus on the role of the gut microbiome in blood pressure regulation and discuss its clinical implications, as well as the challenges and potential of microbiome research.

    • Joanne A. O’Donnell
    • , Tenghao Zheng
    •  & Francine Z. Marques

  • Review Article |

    Gut microbiome studies have potential to provide novel therapeutic targets in chronic kidney disease. Here, the authors not only examine the current state of the field and discuss potential gut-related therapies for targeting uraemic metabolites, but also provide guidelines for improving microbiome study design, and data collection and analysis.

    • Hubert Krukowski
    • , Sophie Valkenburg
    •  & Griet Glorieux

  • Comment |

    Long COVID, which refers to post-acute and chronic sequelae of SARS-CoV-2 infection, can affect nearly every organ system and all demographic groups. The high and growing toll of long COVID calls for an urgent need to understand how to prevent and treat it. Governments and health systems must address the care needs of people with long COVID.

    • Ziyad Al-Aly
    • , Anupam Agarwal
    •  & Valerie A. Luyckx

  • Review Article |

    The COVID-19 pandemic was met with large-scale efforts to assess novel and repurposed therapeutic interventions that could reduce patient morbidity and mortality. Here, the authors discuss the different types of therapies available to treat COVID-19, including their relevance to patients with kidney failure and kidney transplant recipients.

    • Naoka Murakami
    • , Robert Hayden
    •  & David E. Leaf

  • Review Article |

    Effective vaccination strategies are crucial to mitigate the high risk of infection-associated morbidity and mortality in patients with kidney failure. Here, the authors examine vaccine-induced immunity in these patients, in particular their responses to COVID-19 vaccination, in the context of the immune impairment induced by kidney dysfunction and the use of immunosuppressive medications.

    • Nina Babel
    • , Christian Hugo
    •  & Timm H. Westhoff

  • News & Views |

    Although direct kidney infection by SARS-CoV-2 remains controversial, a study based largely on autopsies shows increased tubulointerstitial fibrosis in patients with COVID-19 and suggests direct kidney infection. Moreover, in human kidney organoids, SARS-CoV-2 infection upregulates several pro-fibrotic and pro-inflammatory pathways.

    • Luise Hassler
    •  & Daniel Batlle

  • Editorial |

    Vaccines against SARS-CoV-2 are key to ending the COVID-19 pandemic, but their success depends on global availability and acceptance, as well as measures to protect the most vulnerable.

  • Comment |

    Vaccination against SARS-CoV-2 seems to be safe in patients with immunity-mediated kidney disease, although their immunological responses to vaccination are impaired. Further strategies, including the administration of additional vaccine doses and passive immunization with long-acting monoclonal antibodies, might increase protection in this vulnerable patient group.

    • Maria Prendecki
    • , Michelle Willicombe
    •  & Stephen P. McAdoo

  • Comment |

    Patients receiving dialysis are at high risk of contracting SARS-CoV-2 and developing severe COVID-19. Established SARS-CoV-2 vaccination schemes might lack efficacy in these patients and a personalized approach is therefore necessary. Importantly, given the enhanced infection risks associated with dialysis, current vaccines do not replace non-pharmacological measures to prevent infection.

    • Benjamin Wilde
    • , Johannes Korth
    •  & Andreas Kribben

  • Comment |

    Kidney transplant recipients receive therapeutic immunosuppression that impairs their immune responses to the COVID-19 mRNA vaccine. For this reason, this vulnerable patient population is insufficiently protected by the standard two-dose COVID-19 vaccination programme and requires a specific follow-up to guide personalization of an intensified vaccination approach.

    • Sophie Caillard
    •  & Olivier Thaunat

  • Review Article |

    Acute kidney injury (AKI) is a common complication of COVID-19. This Review describes current understanding of the pathophysiology of COVID-19-associated AKI, examining potential mechanisms by which SARS-CoV-2 infection might induce direct and indirect effects on the kidney and non-specific factors, including haemodynamic changes and/or organ crosstalk, that may adversely influence kidney function.

    • Matthieu Legrand
    • , Samira Bell
    •  & Vincenzo Cantaluppi

  • Comment |

    Patients with kidney diseases should be prioritized for COVID-19 vaccination and the available data suggest that replication-defective viral-vectored vaccines and mRNA vaccines are safe to use. As vaccine responses are likely to be lower in patients with kidney diseases than in the general population, highly potent vaccines should be preferred.

    • Martin Windpessl
    • , Annette Bruchfeld
    •  & Andreas Kronbichler

  • Year in Review |

    The consequences of the COVID-19 pandemic have been devastating; however, evidence suggests that patients with, or at risk of, kidney disease are disproportionally affected. Patients on dialysis and kidney transplant recipients are at higher risk of adverse outcomes from COVID-19, whereas, conversely, patients with severe COVID-19 are at increased risk of acute kidney injury, with short-term and possibly long-term consequences for nephrological care.

    • Annette Bruchfeld

  • Review Article |

    This Review describes our current understanding of the pathogenic mechanisms involved in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the progression of coronavirus disease 2019 (COVID-19), focusing on the immunological hyper-response and the induction of widespread endothelial damage, complement-associated blood clotting and systemic microangiopathy, as well as the effects of these processes on the kidney. The authors also discuss therapeutic interventions that currently hold most promise.

    • Luca Perico
    • , Ariela Benigni
    •  & Giuseppe Remuzzi

  • Consensus Statement
    | Open Access

    COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and is an independent risk factor for all-cause in-hospital death in patients with COVID-19. This Consensus Statement from the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI and for areas of future research, with the aim of improving understanding of the underlying processes and outcomes for patients with COVID-19 AKI.

    • Mitra K. Nadim
    • , Lui G. Forni
    •  & John A. Kellum

  • News & Views |

    A new study examined post-mortem kidney tissue from 63 patients with COVID-19. The results suggest that SARS-CoV-2 has kidney tropism, including the ability to replicate in kidney cells, and that kidney transduction by SARS-CoV-2 is associated with shorter survival time and increased incidence of acute kidney injury.

    • Anitha Vijayan
    •  & Benjamin D. Humphreys

  • Comment |

    Interest in the use of haemoperfusion for severe COVID-19 has been spurred by anecdotal reports of its efficacy and expert reviews suggesting theoretical benefits. However, on the basis of the limited current evidence, haemoperfusion remains an experimental therapy that should only be applied within the context of well-designed randomized trials.

    • Edward G. Clark
    • , Swapnil Hiremath
    •  & Michael Joannidis

  • News & Views |

    A new study uses the OpenSAFELY health analytics platform to identify risk factors for COVID-19 mortality. This analysis, which includes data for more than 17 million people in the UK, suggests that patients with chronic kidney disease are at higher risk than those with other known risk factors, including chronic heart and lung disease.

    • Ron T. Gansevoort
    •  & Luuk B. Hilbrands

  • Comment |

    Management of kidney transplant recipients requires a sustainable infrastructure that can provide reliable medical care both before and after transplantation. The COVID-19 pandemic has disrupted transplant referral and listing processes, led to decreases in the numbers of transplant procedures and resulted in changes in practice for pre- and post-transplantation management and follow-up.

    • Sami Alasfar
    •  & Robin K. Avery

  • World View |

    Brazil has been severely affected by the novel coronavirus. At a time when the country needs to concentrate on controlling and fighting the virus, President Bolsonaro has minimized the importance of the pandemic and focused on political battles.

    • Daniela Ponce

  • Review Article |

    The microbiome is increasingly recognized as an element that contributes to health and disease. Here, the authors take an ecological approach to describe the impact of factors related to chronic kidney disease on the fitness of different physiological systems and the effects of these changes on microbiota composition.

    • Björn Meijers
    • , Pieter Evenepoel
    •  & Hans-Joachim Anders

  • Review Article |

    Antimicrobial resistance is an emergent global problem and patients with chronic kidney disease have some of the highest rates of colonization and infection with antibiotic-resistant bacteria (ARB). This Review focuses on the epidemiology, prevention and treatment of infections with ARB.

    • Tina Z. Wang
    • , Rosy Priya L. Kodiyanplakkal
    •  & David P. Calfee

  • Review Article |

    This Review describes the reciprocal interactions between the immune system and the intestinal microbiota, focusing on components of the immune system that drive chronic diseases that involve the kidney. The authors also discuss limitations of current approaches to microbiota research and emphasize the need to move beyond studies of correlation to causation.

    • Felix Knauf
    • , J. Richard Brewer
    •  & Richard A. Flavell

  • Review Article |

    This Review describes the epidemiology and mechanisms underlying the reciprocal relationship between hepatitis C virus (HCV) infection and chronic kidney disease (CKD). The authors also discuss recommended treatment approaches for patients with HCV infection and CKD, and outline remaining issues in the field.

    • Stanislas Pol
    • , Lucia Parlati
    •  & Michel Jadoul

  • News & Views |

    Antiviral treatment options for HCV-infected patients with advanced kidney disease are limited because few clinical trials have tested the efficacy of antiviral drugs in this population. Now, a phase III trial of two pan-genotypic drugs demonstrates excellent viral clearance with minimal adverse events in HCV-infected patients with advanced kidney disease.

    • Marco Ladino
    •  & David Roth

  • News & Views |

    Treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) can be challenging. Now, data from the phase III C-SURFER study show that grazoprevir and elbasvir — a new all-oral combination therapy for HCV — is safe and effective in patients with stage 4–5 CKD.

    • Henry Lik-Yuen Chan
    •  & Philip Kam-Tao Li

  • Review Article |

    Urinary tract infections (UTIs), including pyelonephritis, are among the most common and serious infections encountered by nephrologists. Emerging evidence suggests a fundamental role for the innate immune system in protecting the urothelium from bacterial challenge. This Review provides an overview of UTI pathogenesis in the upper and lower urinary tract. The authors describe the role of intercalated cells and the innate immune response in preventing UTI, focusing on the role of antimicrobial peptides in maintaining urinary tract sterility.

    • Brian Becknell
    • , Andrew Schwaderer
    •  & John David Spencer

  • Review Article |

    Resident microorganisms in the human body vastly outnumber host cells and have an important role in human physiology. In this Review, Bromberg and colleagues discuss the basic principles that guide analyses of the microbiota, including the challenges of measuring and quantifying microbiota. They also discuss the influence of the microbiota on the immune system and the implications of these effects on organ failure and transplantation.

    • Jonathan S. Bromberg
    • , W. Florian Fricke
    •  & Emmanuel F. Mongodin

  • Opinion |

    Lupus nephritis is a complication of systemic lupus erythematosus, a heterogeneous autoimmune syndrome that involves multiple pathogenetic pathways. Here, Adriana Migliorini and Hans-Joachim Anders summarize accumulating data from the fields of genetics, clinical science, transcriptomics and basic immunology which indicate that antiviral immunity is involved in the pathogenesis of lupus nephritis. The authors also discuss the potential implications for innovative therapeutic strategies.

    • Adriana Migliorini
    •  & Hans-Joachim Anders

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