Articles in 2023

Climate change is increasing global temperatures and causing more frequent and severe extreme heat events. The resulting additional disease burden is inequitably distributed. Strategies that reduce inequities in heat exposure and vulnerability to heat-related illness, as well as health protections at multiple levels (from individual to regional), are urgently needed to contain the looming crisis.

An estimated 10–15% of individuals with hypertension are resistant to available antihypertensive therapies. Findings from two new clinical trials — BrigHTN and PRECISION — that assessed the blood pressure-lowering effects of the aldosterone synthase inhibitor baxdrostat and the dual endothelin receptor antagonist aprocitentan, respectively, suggest these approaches hold promise for patients with treatment-resistant hypertension.

Adequate nutrition is essential for kidney health; however, attempts to improve nutrition and food security have been hindered in recent years by man-made and natural disasters. Approaches to eradicate famine, improve nutritional status and reduce food insecurity are needed to reduce inequities and maintain kidney health in the face of adverse circumstances.

The COVID-19 pandemic exposed flaws in the ability of the nephrology community to efficiently inform clinical decision making. To improve preparedness for the next pandemic, the nephrology community must work more closely together to ensure that research efforts are aligned and put in place a strategy for the effective dissemination of high-quality evidence in real-time.

This Review discusses the potential mechanisms by which regular exercise has beneficial effects on chronic inflammation, cardiovascular health, lipid metabolism, insulin resistance, sarcopenia and bone health in people with kidney disease. The authors highlight areas for further investigation to enhance the benefits of exercise for this population.

Any processes that impair kidney development in the developing fetus can have lifelong adverse consequences for renal health. Here, the authors discuss the effects of preterm birth and/or intrauterine growth restriction on kidney development and the impact of these exposures on the later development of chronic kidney disease.

Immune dysregulation contributes to the pathogenesis of preeclampsia. Here, the authors examine the role of immune cells and mediators in driving the oxidative stress and endothelial dysfunction that characterize this hypertensive disorder of pregnancy.

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.

In this Review, the authors discuss the mineral-related factors and kidney-derived molecules that regulate osteocyte FGF23 production in health and disease. They also highlight potential approaches to the treatment of FGF23-related disorders of mineral metabolism that target key bone–kidney interactions.

Primary hyperoxaluria is an inherited disorder that results from the overproduction of endogenous oxalate, leading to recurrent kidney stones, nephrocalcinosis, kidney failure and life-threatening systemic disease. This Consensus Statement from ERKNet and OxalEurope provides recommendations for the management of primary hyperoxaluria, including consideration of conventional therapies, new therapies and recommendations for patient follow-up.

Necroptosis is a form of necrotic cell death that leads to cell lysis and an inflammatory response in neighbouring tissues. This Review describes the molecular mechanisms that regulate the induction of necroptosis and current evidence implicating a role for necroptosis in the pathogenesis of kidney diseases.

Pyroptosis is a form of regulated cell death that is mediated by the membrane-targeting, pore-forming gasdermin family of proteins. Here, the authors provide an overview of the basic biology of gasdermins and pyroptosis with a focus on the mechanisms by which these proteins may contribute to kidney disease.