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Technological advances are providing unprecedented opportunities to analyse biological systems at the single-cell level. This Review describes the fundamental concepts of single-cell RNA analysis and specific applications of the technology for the study of development, cancer and normal and diseased kidneys.
Acute kidney injury (AKI) is characterized by the activation of intra-renal haemostatic and inflammatory processes. Here, the authors discuss the role of platelets as modulators of inflammation and haemostasis at the site of vascular injury, their interactions with endothelial cells and leukocytes and current antiplatelet strategies in AKI.
Increasing evidence suggests an important role of the gut microbiota in the development of hypertension and chronic kidney disease. In this Review, the authors explain their brain–gut–kidney axis hypothesis for the pathogenesis of these diseases.
Haemodialysis membranes are traditionally classified on the basis of their composition and water permeability. In this Review, the authors discuss the advances in materials technology, polymer chemistry, surface functionalization and dialyser assembly that mandate new classification approaches.
Technologies such as proteomics provide a snapshot of a specific cellular state but are unable to directly record successive signalling events. Two new CRISPR-mediated analogue multi-event recording apparatus (CAMERA) systems enable sequential recording of endogenous and exogenous signalling events by targeted DNA modifications, thereby allowing systematic interrogation of different cellular states.
Although most nephrologists spend their days managing patients with acute and chronic kidney disease (CKD), it is useful to occasionally consider the landscape of our current treatment approach. Here, we present the hypothesis that the major mechanisms that drive CKD are changing and will necessitate new approaches to manage this disease.
A new subclassification of diabetes based on quantitative traits, including age, body mass index, insulin resistance and β-cell function suggests five clusters with distinct phenotypes and prognoses. This approach may offer a novel way to classify diabetes by providing more information on risks and potential therapeutic strategies.
An unbiased functional gene knockout screen to identify genes implicated in Hedgehog signalling in primary cilia detected most components of the ciliary machinery and ciliopathy-associated genes, but no kidney-related ciliopathy genes. The 472 hits are a tremendous resource for identifying potential ciliopathy genes and for analysing ciliary function and signalling pathways.
In this Review, the authors discuss the epidemiology, diagnosis and optimal management of resistant hypertension. They highlight the limitations of clinical trials of device-based therapies conducted to date and propose directions for future research.
Dysfunction of one or more organs is a common occurrence in patients with sepsis owing to microcirculatory alterations and cellular dysfunction. In this Review, the authors summarize knowledge of the mechanisms that underlie organ failure in sepsis and discuss how these insights are providing targets for the treatment of sepsis.
Two new clinical trials together involving nearly 30,000 patients support previous observational evidence that the most common solution used for intravenous fluid therapy in the world is associated with kidney damage. Both trials found that 0.9% saline was inferior to solutions with more physiological chloride concentrations and resulted in greater rates of major adverse kidney events.
Patients who present with chronic kidney disease and diabetes mellitus can have true diabetic kidney disease (DKD), nondiabetic kidney disease (NDKD), or a combination of both DKD and NDKD. Here, Anders and colleagues discuss the mechanisms underlying these entities and how greater appreciation of distinctions between these entities might facilitate the development of new treatments.
A recent observational study reports that implantable cardioverter defibrillators were not associated with improved survival in patients with heart failure, reduced left ventricular ejection fraction and chronic kidney disease. Further studies are needed to identify which of these high-risk patients are most likely to benefit from this potentially life-saving therapy.
