Reviews & Analysis

The complement system is often involved in immune-driven kidney injury. In this Review, the authors discuss complement activation in a variety of kidney diseases, including conditions not traditionally considered to be immune-mediated, and the potential of complement therapeutics for the treatment of kidney disease.

A recent study reports that adenosine A2A receptor-mediated lymphangiogenesis increases lymphatic clearance of excess Na⁺ from the skin and reduces blood pressure, whereas impairment of this process leads to salt-sensitive hypertension. These findings raise intriguing physiological questions regarding the relationships among sodium, water and blood pressure.

This Review summarizes our current understanding of sex differences in renal fluid and electrolyte transporters, based primarily on studies in rodents. The authors describe the physiological consequences of these differences, based on information from experimental studies and from model predictions, and discuss the differential impact of sex on transporter regulation by hormones, diet and acid–base status.

Here, the authors review the current understanding of interorgan crosstalk mechanisms, with a focus on interorgan communication in the kidney–lung axis during acute or chronic disease of the kidney or lung.

Several factors complicate the identification of effective interventions that can improve the outcomes of patients with acute kidney injury (AKI). Here, the authors discuss key design considerations for clinical trials in hospitalized patients with AKI, including the selection of adequate patient cohorts and study end points.

Primary aldosteronism is the most common cause of endocrine arterial hypertension and is characterized by the autonomous production of aldosterone from one or both adrenal glands. This Review describes the molecular discoveries and developments that have the potential to transform the clinical management of patients with this disease.

Here, the authors review techniques for cardiovascular diagnosis, screening and monitoring in patients with CKD, including approaches to the diagnosis of cardiac ischaemia, left ventricular hypertrophy and dysfunction, arrhythmia, cerebrovascular disease, peripheral arterial disease, arterial stiffness and hypertension.

Perivascular cells have beneficial roles that maintain kidney homeostasis but can also contribute to kidney pathology. Here, the authors focus mainly on pericytes and fibroblasts to examine these roles, including the contribution of perivascular cells to the myofibroblast pool in kidney fibrosis, and their crosstalk with tubular, immune and endothelial cells.

Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of the disease. The authors of this Review describe the different inequities that affect kidney health and care worldwide, and consider potential solutions to help to mitigate these.

In this Consensus Statement, the authors discuss a framework for the development, validation and implementation of digital health technologies across the acute kidney injury continuum — risk prediction, prevention, detection and management.

Racial and ethnic minoritized populations are underrepresented in clinical trials in nephrology, but overrepresented in adverse kidney disease outcomes. Targeted enrolment, revision of problematic policies, inclusion of minoritized populations in trial planning, and language-, race- and ethnicity-concordant investigative teams can improve representation in clinical trials.

Here, the authors provide an overview of genetic causes of CAKUT and their impact on signalling pathways during nephrogenesis. They also discuss the impact of a molecular genetic diagnosis on the clinical care and potentially the personalized treatment of patients with CAKUT.

In a ground-breaking development, rat kidneys have been cryopreserved for an unprecedented duration of 100 days and subsequently transplanted successfully after nano-rewarming. This extraordinary achievement opens new possibilities for the field of organ banking.

Chronic kidney disease is characterized by dyslipidaemia and lipid accumulation in the kidney. In this Review, the authors examine the evidence that links alterations in lipid metabolism to kidney injury and progression of kidney disease, and explore potential lipid-targeted therapeutic approaches.

Kidney failure is a serious but rare consequence of progressive chronic kidney disease. A meta-analysis of individual participant-level trial data, across heterogeneous treatments and disease groups, has shown glomerular filtration rate (GFR) slope to be a valid, fit-for-purpose and robust surrogate marker of kidney failure.

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.

During disasters, the morbidity and mortality of patients with kidney disease far exceeds that of the general population. Here, the authors discuss the medical and logistical problems that are faced by these patients and their care-givers during mass disasters and suggest pragmatic approaches to improve patient outcomes.

The bladder and kidney engage adaptive and innate immune responses to prevent urinary tract infections and minimize tissue injury following infection. Here, the authors describe the mechanisms used by uropathogenic bacteria to establish and promote kidney infection, as well as the immune defence mechanisms used by resident kidney cells and infiltrating immune cells to eradicate infection.

Aquaporins have diverse roles in various homeostatic and physiological systems beyond their role in renal water handling. This Review describes the role of mammalian aquaporins in the transport of solutes other than water and their involvement in processes such as metabolism, cellular migration, cell adhesion, cell polarity and cell signalling.

This Review examines insights from genetic studies of systemic lupus erythematosus (SLE), including observations from reports of monogenic SLE, as well as the role of common and rare variants. The authors also discuss age-associated B cells, as the integration of genetic, epigenetic and transcriptomic data suggests a key role for these cells in SLE.