Articles in 2021

Glucocorticoid exposure remains a major contributor to morbidity and mortality in patients with immune-mediated kidney disease. Recent clinical trials have tested novel potential therapies for these patients and showed that glucocorticoid doses can be reduced without compromising efficacy.

Chronic kidney disease is a major public health problem that is associated with excessive morbidity, mortality and healthcare costs. However, limited clinician awareness of chronic kidney disease is universally identified as a key barrier to care. A concerted effort is urgently needed to address the knowledge gaps of primary care providers.

Mutations in ~35 genes have been identified as monogenic causes of kidney stone disease, and gene variants have been associated with stone disease in the general population. Here, the authors discuss the genetic and molecular basis of kidney stone disease and nephrocalcinosis.

This Review examines the concept of kidney lifespan and how increases in haemodynamic and metabolic demands in the kidney can lead to nephron overload, which is a common feature of progressive kidney disease and therefore represents a therapeutic target.

The dramatic increase in advocacy and scholarly work on the impact of structural racism on health inequities that began in 2020 has been sustained in the past year. In response to the call for action on these issues, the nephrology community has developed policy-based mitigation strategies and continues to examine our role in promoting health equity and justice in the care of patients with kidney disease.

Patients with kidney disease are particularly vulnerable to COVID-19. In 2021, key studies demonstrated the safety of renin–angiotensin blockade in patients with kidney failure and COVID-19, and provided new data on the therapeutic potential of soluble angiotensin-converting enzyme, COVID-19 vaccine responses and the long-term effects of COVID-19 on kidney function.

In 2021, extreme weather and climate events caused preventable injuries, illnesses and deaths. A clear imperative exists to reduce greenhouse gas emissions and increase the sustainability and climate resilience of health systems. Countries and communities must implement strategies to mitigate climate change and invest in health systems to protect their populations.

New DAPA-CKD trial analyses have confirmed the outstanding renoprotective benefits of sodium–glucose co-transporter 2 inhibitors, independently of the presence of diabetes or the stage of kidney disease. Moreover, the non-steroidal mineralocorticoid receptor antagonist finerenone provides renal and cardiovascular protection in diabetic kidney disease when combined with renin–angiotensin–aldosterone system inhibitors.

Quality geriatric kidney care extends beyond traditional therapy to care that balances the impact of both disease and treatment around how individuals manage their daily routines. In this Comment, we discuss clinical and policy changes that could benefit older people with advanced kidney disease.

We saw impressive progress in our understanding of the genetics of kidney function and disease in 2021. Genome-wide association studies defined key common variants for kidney function and disease, and multi-omics methods, including quantitative trait analyses and single cell studies, illuminated key genes and cell types responsible for disease development.

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.

Here, the authors discuss how structural racism underlies many of the health disparities that affect individuals from minority racial groups. They also examine how the use of race coefficients in estimated glomerular filtration rate equations might contribute to health inequities in Black patients with kidney disease.