Reviews & Analysis

Here, the authors discuss the effects of salt intake on health outcomes, the factors that determine individual susceptibility to dietary salt and approaches to reducing salt intake and improving health at the population and individual levels.

‘Metabolic dysfunction-associated fatty liver disease’ has been proposed as a replacement term for ‘Non-alcoholic fatty liver disease’, in part to recognize the fact that this liver disease occurs within a series of complex metabolic disorders. This Perspective article discusses the clinical associations and pathophysiological mechanisms underpinning the relationship between metabolic dysfunction-associated fatty liver disease and chronic kidney disease.

Unpleasant symptoms — arising as a consequence of disease processes, comorbid conditions, therapeutics and lifestyle regimens — adversely affect the quality of life and life participation of patients with chronic kidney disease (CKD). This Perspective examines the concept and scope of symptom burden in CKD, theoretical frameworks and validated tools for symptom appraisal, and strategies with which to support patients actively through the identification and targeting of unpleasant symptoms.

Mesangial cells are stromal cells that are important for kidney glomerular homeostasis and the glomerular response to injury. This Perspective reviews advances in our understanding of mesenchymal stromal cell function and describes how these insights can inform our understanding of mesangial cells and their role in disease.

Focal segmental glomerulosclerosis is a histopathological lesion that has heterogeneous causes. In this Perspectives article, the authors outline a rationale for the stratification of focal segmental glomerulosclerosis based on current understanding of the pathophysiology of podocyte stress and damage and propose that such an approach will improve the rational design and success of therapeutic trials.

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.

SGLT2 inhibitors induce a number of metabolic adaptations in response to increased glucose and Na⁺ excretion. This Perspective article describes how these adaptations suggest that SGLT2 inhibition triggers a body water-conserving mechanism, and discusses how these metabolic adjustments may contribute to the favourable cardiovascular and renal outcomes of this class of therapeutics.

Here, the ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology highlights ten areas of ethical concern as priority challenges that require collaborative action and discusses the need for development of ethical training and guidance tools to manage these issues.

This Perspectives article, written on behalf of the participants of the NIDDK Workshop on ‘Sex and the Kidneys’, considers opportunities for clinical, basic and translational research into sex differences in renal disease as well as the potential tools and resources needed to conduct this research.

The authors of this Perspectives article describe the physiological and statistical principles underlying measured glomerular filtration rate (mGFR) and estimated glomerular filtration rate (eGFR). They discuss their limitations, the circumstances under which mGFR and eGFR should be used, and approaches to improve these methodologies.

This Perspectives article considers why clinical trials of urate-lowering therapy (ULT) have shown inconsistent renoprotective effects in patients with chronic kidney disease, and suggests that sufficient evidence exists to support the use of routine screening for hyperuricaemia and initiation of ULT in selected patients.

In this Perspectives article, Porrini and colleagues appraise the results of studies that have compared the performance of formulae developed to estimate glomerular filtration rate (GFR) against measured GFR reference methods. They contend that the persistence of errors in GFR estimation formulae indicates an inadequacy of serum creatinine and cystatin C levels as markers of actual renal function.

This Perspectives article describes supporting and contradicting data regarding the role of podocyte B7-1 in the pathogenesis of various podocytopathies and highlights issues that need to be addressed to standardize approaches to the study of this protein.