Articles in 2023

Individuals who are members of multiple marginalized populations experience multiple axes of oppression and discrimination. Such intersectional discrimination can have interactive, negative effects on all aspects of life, including health. To achieve health equity, intersectional-discrimination-induced kidney harms must be examined, measured and mitigated.

Chronic kidney disease (CKD) is highly prevalent in women in perimenopause and menopause. Both CKD and menopause affect several important pathologies, such as cardiovascular disease (CVD) and bone mineral disease. More research is needed to better understand the relationships between menopause, CKD, CVD and bone disease.

Mentoring is an essential component of scientific leadership and can have a profound impact on the development and life course of the mentee. Isi Ero-Tolliver, Dean of the School of Science at Hampton University, describes the life-changing and long-lasting effects of mentorship and why it is important to invest time and effort in mentoring.

The importance of incorporating factors related to sex and gender in all aspects of research is increasingly recognized. Kidney disease pathophysiology, presentation, response to therapy and outcomes differ by sex and gender, but these factors are often not considered in basic and clinical studies. It is time for nephrology to catch up.

Transgender persons can face a number of barriers in accessing primary and specialist care that is equitable, inclusive and appropriate for their needs. In this Viewpoint, commissioned to recognize Pride, five researchers with expertise across different disciplines, including nephrology, endocrinology, public health, psychology and sociology, provide their perspectives on key considerations that are required to achieve optimal primary and nephrology care for transgender individuals, including barriers to care and how these might be overcome to ensure that the provision of care is inclusive and safe.

Complement proteins and receptors with intracellular activity — the complosome — have emerged as important regulators of physiological processes. In this Review, the authors examine evidence of complosome activity across a variety of cells and tissues, as well as their contributions to human disease and therapeutic potential.

Here, the authors discuss tertiary lymphoid structure (TLS) development, maintenance and function, with a focus on the roles of TLSs in autoimmune disease, cancer, infection and chronic age-related inflammatory diseases. They also discuss the clinical implications of TLSs in various tissues and diseases.

Specific policies embedded in organ and tissue donation and transplantation systems discriminate against sexual orientation- and gender identity-diverse populations, restricting or excluding the use of donated organs and tissues. Revision of these policies is needed to promote equity and increase the supply of high-quality organs and tissues for those who need them.

In this Review, the authors describe biological networks, discuss the properties that make these networks ideal for understanding how diseases arise from complex interactions of molecular and cellular systems, and explore how network medicine can be used to improve understanding of kidney and renovascular diseases.

The advancement of women to leadership positions in nephrology lags behind that of men by several metrics. Proactive, intentional approaches, including mentorship and sponsorship, family-friendly policies, career development in hard and soft skills, combatting bias and use of transparent institutional metrics of women’s advancement, are required to address this disparity.

In this Review, the authors discuss the molecular and cellular mechanisms by which pathogenic variants in various genes cause distal renal tubular acidosis with renal and extrarenal manifestations. They also discuss acquired and incomplete forms of distal renal tubular acidosis.

Understanding of the barriers to adequate health care experienced by sexual and gender minority (SGM) people cannot be achieved in the absence of robust and appropriate data. The inclusion of SGM populations in health research and the collection of sexual orientation and gender identity data in research and routine clinical practice is therefore essential to understanding the unique needs of these populations and addressing inequities in health outcomes.

Renal cell carcinoma is sensitive to immune checkpoint blockade despite having a moderate traditional tumour mutational burden profile. Here, the authors discuss how the high prevalence of frameshift insertion or deletions in renal cell carcinoma, as well as the reactivation of endogenous retroviral gene expression, might provide alternative neoantigens that potentiate responses to immunotherapy.

Despite advances in cell and gene therapy for the treatment of disease, no such interventions currently target the kidney. Here, the authors review the potential for cell and gene therapies to be applied to kidney disease, highlighting recent genetic studies, key technical advances and considerations, and areas for further investigation.

Blockchains enable secure data storage, the verification of data origin and accurate registration of changes in information over time. The widespread adoption of blockchain in nephrology could affect clinical practice and research by enhancing the quality of electronic health records and datasets.

Pathways of regulated cell death may contribute to the pathogenesis of various kidney diseases. Here, the authors provide an overview of the relationship between necroptosis, pyroptosis, ferroptosis and apoptosis, the evidence supporting a role for these regulated pathways of necrosis in kidney disease, strategies for therapeutic targeting and research needs.