Reviews & Analysis

The development of acute kidney injury (AKI) after major non-cardiac surgery is associated with substantial long-term morbidity and mortality. This joint Consensus Statement from the Acute Disease Quality Initiative and the PeriOperative Quality Initiative provides recommendations for the definition, prevention and management of postoperative AKI.

Chronic kidney disease (CKD) is associated with alterations in serum lipid profiles that contribute to kidney and cardiovascular disease. Here, the authors examine these changes in serum levels, metabolism and post-translational modifications of lipoproteins and fatty acids that characterize CKD-associated dyslipidaemia.

Knowledge of complement genetics has improved understanding of the pathogenesis of primary atypical haemolytic uraemic syndrome (aHUS). This Review summarizes current knowledge of complement genetics in aHUS and discusses how complement studies affect the management of patients with other thrombotic microangiopathies.

Organ transplantation improves patient survival and quality of life and has a major beneficial impact on public health and the socio-economic burden of organ failure. This Roadmap presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation.

Dysregulated expression of metalloproteinases is observed in many forms of kidney disease. Here, the authors focus on the roles of the matrix metalloproteinase and a disintegrin and metalloproteinase families of proteins, as well as their regulators, in kidney disease processes and explore the therapeutic potential of novel metalloproteinase inhibitors.

Immune cells have important roles in many kidney diseases and their phenotypes are intricately connected to their metabolic profiles. Here, the authors explore the metabolic programs of different kidney immune cells and their phenotypes, and the potential of targeting immunometabolism in the kidney.

The renin–angiotensin system is essential for the regulation of blood pressure and extracellular fluid volume and composition. This Review describes mechanisms that regulate the production of renin in the collecting duct and the local interactions that underlie the contributions of the distal nephron renin–angiotensin system to the pathogenesis of hypertension and kidney injury.

Patients with haematological cancer are at risk of kidney injury, whether as a direct consequence of the malignancy or because of treatment-related effects. Here, the authors review the most common causes of kidney injury in these patients and discuss their pathophysiology, presentation and management.

The adult kidney vasculature comprises diverse populations of endothelial cells that support specific functions according to their microenvironment. This Review summarizes our current understanding of the phenotypic, molecular and metabolic heterogeneity of renal endothelial cells in relation to their microenvironment and the potential application of targeting renal endothelial cell metabolism as a therapeutic strategy for kidney diseases or kidney regeneration.

Glucocorticoids have, for decades, been an enduring component of treatment regimens for anti-neutrophil cytoplasm autoantibody (ANCA)-associated vasculitis. However, a growing number of studies have encouraged a move towards reduced glucocorticoid usage. Findings of the ADVOCATE trial suggest that complement blockade may pave the way for complete glucocorticoid avoidance.

Chronic kidney disease is characterized by the retention of uraemic toxins, which can damage organs, including the cardiovascular system. Removal of these toxins by current dialysis modalities is inadequate, highlighting a need for new strategies. This Review summarizes pharmacological and non-pharmacological means of abrogating the effects of uraemic toxins.

The concepts of kidney damage and dysfunction, including subclinical damage and loss of renal functional reserve, are relevant to the detection of acute kidney injury (AKI). Here, the authors examine these concepts, as well as AKI duration and relapse, and discuss potential changes to AKI classification criteria.

In this Review, the authors discuss the renal mechanism of salt-sensitive hypertension induced by malnutrition during pregnancy, obesity in adult life and ageing. They also describe the epigenetic mechanisms that potentially contribute to the development of salt-sensitive hypertension in these settings.

Multiple pathophysiological disturbances contribute to the onset and progression of diabetic kidney disease (DKD). This Review describes these pathogenic processes and discusses the ability of sodium–glucose co-transporter 2 (SGLT2) inhibitors to correct or improve many of these processes, which are likely to underlie the ability of these agents to slow progression of established diabetic kidney disease.

In this Review, the authors examine the physiological heterogeneity of different kidney compartments and consider how the local oxygen supply and the capacity for metabolic adaptation of different nephron segments might influence their response to changes in oxygen availability and their susceptibility to injury.

Planar cell polarity (PCP) refers to the coordinated orientation of cells in the tissue plane and is important for several key morphogenetic and homeostatic processes. This Review describes the origins of PCP signalling, its activity and cellular targets, with an emphasis on the PCP pathway in kidney development, function and disease.

Here, experts from the European Reference Network for Kidney Diseases and the European Society for Paediatric Nephrology present recommendations for the management of congenital nephrotic syndrome, including the use of renin–angiotensin system inhibitors, diuretics, anticoagulation and infection prophylaxis.

Calcium oxalate kidney stones are often found attached to Randall’s plaques in the kidney papilla. Here, the authors examine the mechanisms underlying the formation of Randall’s plaques, including the role of mineralization modulators, as well as inflammation and immune cells.